person
Mckenna Ivy Shofroth, RN
General Practice Registered Nurse in Maryville, Illinois
NPI 1962158501

Mckenna Ivy Shofroth is a General Practice Registered Nurse based in Maryville, IL and is specialized in General Practice. Mckenna Ivy Shofroth practices in Maryville, IL and has the professional credentials of RN. The NPI Number for Mckenna Ivy Shofroth is 1962158501 and holds a License No. 041521566 (Illinois).

The current practice location address for Mckenna Ivy Shofroth is 20 Professional Park Dr Ste B, Maryville, IL and can be reached out via phone at 618-288-1480 and via fax at 888-718-4696.

Location: 20 Professional Park Dr Ste B, Maryville, IL, 62062-5830
person
Provider Profile Details
NPI Number
1962158501
Provider Name
Mckenna Ivy Shofroth
Credential
RN
Provider Entity Type
Individual
Gender
Female
Address
20 Professional Park Dr Ste B, Maryville, IL, 62062-5830
Phone Number
618-288-1480
Fax Number
888-718-4696
Provider Enumeration Date
02/22/2022
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1417916099 05 IL
institution
Provider Business Practice Location Address Details
Address
20 Professional Park Dr Ste B
City
State
Zip
62062-5830
Phone Number
618-288-1480
Fax Number
888-718-4696
person
Provider Business Mailing Address Details
Address
20 Professional Park Dr Ste B
City
State
Zip
62062-5830
Phone Number
618-288-1480
Fax Number
888-718-4696
person
Provider's Taxonomy Details 1
Type
Nursing Service Providers
Classification
Registered Nurse
Speciality
General Practice
Taxonomy
License No.
041521566 (Illinois)
Definition
Definition to come...
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