Healthcare Provider Details

I. General information

NPI: 1598005993
Provider Name (Legal Business Name): RONNA R HURREN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 MEDICAL PARK DR SUITE 2
EFFINGHAM IL
62401-2193
US

IV. Provider business mailing address

904 MEDICAL PARK DR SUITE 2
EFFINGHAM IL
62401-2193
US

V. Phone/Fax

Practice location:
  • Phone: 217-347-2255
  • Fax: 217-342-6910
Mailing address:
  • Phone: 217-347-2255
  • Fax: 217-342-6910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number041325656
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: