Healthcare Provider Details

I. General information

NPI: 1518182401
Provider Name (Legal Business Name): DENISE RENAE SONS RN,CNOR,CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 N 1ST ST BOX 721
FAIRFIELD IL
62837-2466
US

IV. Provider business mailing address

PO BOX 721 1207 NORTH FIRST STREET
FAIRFIELD IL
62837-0721
US

V. Phone/Fax

Practice location:
  • Phone: 618-237-8770
  • Fax: 618-847-4206
Mailing address:
  • Phone: 618-237-8770
  • Fax: 618-847-4206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number0041-282852
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: