Healthcare Provider Details

I. General information

NPI: 1033116587
Provider Name (Legal Business Name): DONNA MCGHEE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 PARK PL
SWANSEA IL
62226-2923
US

IV. Provider business mailing address

12 PARK PL
SWANSEA IL
62226-2923
US

V. Phone/Fax

Practice location:
  • Phone: 618-233-5722
  • Fax: 618-233-7069
Mailing address:
  • Phone: 618-233-5722
  • Fax: 618-233-7069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: