Healthcare Provider Details

I. General information

NPI: 1215251566
Provider Name (Legal Business Name): STEN V CANTWELL RN FIRST ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E STATE ST
ROCKFORD IL
61104-2315
US

IV. Provider business mailing address

PO BOX 1567
ROCKFORD IL
61110-0067
US

V. Phone/Fax

Practice location:
  • Phone: 815-391-7150
  • Fax: 815-061-2471
Mailing address:
  • Phone: 815-391-7150
  • Fax: 815-061-2471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number163WR0006X
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: