Doctor Name: | PAULA R ICENOGLE |
NPI Number: | 1023281847 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | I25267678827 |
Business Practice Address: | 708 Sherry St Colchester, IL - 623261176 |
Business Phone Number: | 3097763978 |
Business Fax Number: | |
Mailing Address: | 708 Sherry St, COLCHESTER |
State: | IL |
Postal Code: | 623261176 |
Phone Number: | 3097763978 |
Fax Number: | |
NPI Enumeration Date: | 04/13/2008 |
NPI Last Update Date: | 04/13/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 172A00000X |
License Number: | I25267678827 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Driver |
Taxonomy Specialization: | |
Taxonomy Definition: | A person employed to operate a motor vehicle as a carrier of persons or property. |