Healthcare Provider Details

I. General information

NPI: 1285036897
Provider Name (Legal Business Name): TRECIA IHRIG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERRY JOHNSON

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 S GLENSTONE AVE
SPRINGFIELD MO
65802-3206
US

IV. Provider business mailing address

371 HIGHWAY MM
EVERTON MO
65646-8134
US

V. Phone/Fax

Practice location:
  • Phone: 417-581-8170
  • Fax:
Mailing address:
  • Phone: 417-581-8170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number768926
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2008036338
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: