Healthcare Provider Details

I. General information

NPI: 1558021501
Provider Name (Legal Business Name): TRENIECE NICHOLE FINNEY AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 12/17/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 W DEYOUNG ST
MARION IL
62959-5884
US

IV. Provider business mailing address

PO BOX 144
IRVINGTON IL
62848-0144
US

V. Phone/Fax

Practice location:
  • Phone: 618-998-7000
  • Fax:
Mailing address:
  • Phone: 618-204-7322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209.023878
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: