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NPI Code Detail

MEDICARE: MRS. CASSIE LYNN SCROGGINS REGISTERED NURSE

MEDICARE: MRS. CASSIE LYNN SCROGGINS REGISTERED NURSE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WI0600XInfection Control Registered Nurse041418678IL

General Provider Information

NPI Number : 1669192837
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CASSIE LYNN SCROGGINS REGISTERED NURSE
Provider Business Mailing Address
First Line : 509 S COLLEGE ST
Second Line :
City : STAUNTON
State : IL
Zip : 62088-1867
Country : US
Telephone Number : 217-602-1867
Fax Number :
Provider Business Practice Location Address
First Line : 393 E EDWARDSVILLE RD
Second Line :
City : WOOD RIVER
State : IL
Zip : 62095-1646
Country : US
Telephone Number : 618-259-4111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2022
Last Update Date : 08/29/2022

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