=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285036897
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRECIA IHRIG RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2014
-----------------------------------------------------
Last Update Date | 09/25/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 620 S GLENSTONE AVE
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65802-3206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-581-8170
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 371 HIGHWAY MM
-----------------------------------------------------
City | EVERTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65646-8134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-581-8170
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 768926
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 2008036338
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------