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NPI Code Detail

MEDICARE: MACIE KOHNERT APRN

MEDICARE: MACIE KOHNERT APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner209.027964IL

General Provider Information

NPI Number : 1861174260
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACIE KOHNERT APRN
Provider Business Mailing Address
First Line : 611 W PARK ST
Second Line : FAPC
City : URBANA
State : IL
Zip : 61801-2500
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 363 N WEST ST
Second Line :
City : OLNEY
State : IL
Zip : 62450-1160
Country : US
Telephone Number : 618-392-9400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2023
Last Update Date : 12/31/2024

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Directions to “ MACIE KOHNERT APRN” Practice Location

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