Healthcare Provider Details

I. General information

NPI: 1295639995
Provider Name (Legal Business Name): KIM SEARS MUCU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4461 PROGRESS BLVD
PERU IL
61354-1109
US

IV. Provider business mailing address

305 W HOPKINS AVE
GRANVILLE IL
61326-9375
US

V. Phone/Fax

Practice location:
  • Phone: 815-223-9678
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number041.342887
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: