MEDICARE: KIPNGETICH N KORIR RN

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
1	163WM0705X	Medical-Surgical Registered Nurse	234621-30	WI

General Provider Information

NPI Number	:	1932792009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIPNGETICH N KORIR RN

Provider Business Mailing Address
First Line	:	1067 VERMILLION ST
Second Line	:
City	:	PLANO
State	:	IL
Zip	:	60545-3027
Country	:	US
Telephone Number	:	517-575-7523
Fax Number	:

Provider Business Practice Location Address
First Line	:	1067 VERMILLION ST
Second Line	:
City	:	PLANO
State	:	IL
Zip	:	60545-3027
Country	:	US
Telephone Number	:	517-575-7523
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2021
Last Update Date	:	02/18/2021

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