Healthcare Provider Details

I. General information

NPI: 1508452350
Provider Name (Legal Business Name): KARENINA MARIE SLONE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 BARBER CREEK RD
PORT BYRON IL
61275-9200
US

IV. Provider business mailing address

305 BARBER CREEK RD
PORT BYRON IL
61275-9200
US

V. Phone/Fax

Practice location:
  • Phone: 563-340-4444
  • Fax:
Mailing address:
  • Phone: 563-340-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number041.406182
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number110201
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: