Healthcare Provider Details

I. General information

NPI: 1750032736
Provider Name (Legal Business Name): ADDISON HOHNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADDISON NOREEN

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 08/01/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CARPENTER ST
SPRINGFIELD IL
62769-1000
US

IV. Provider business mailing address

800 E CARPENTER ST
SPRINGFIELD IL
62769-1000
US

V. Phone/Fax

Practice location:
  • Phone: 217-544-6464
  • Fax: 217-757-6537
Mailing address:
  • Phone: 217-544-6464
  • Fax: 217-757-6537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041478961
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209.025455
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: