Shofroth, Mckenna Ivy
Shofroth, Mckenna Ivy is an individual health care provider with primary practice located at 20 Professional Park Dr Ste B , Maryville IL 62062-5830. She recently has only one registered license in Nursing Service Providers / General Practice, which is considered as her primary health care specialty. Shofroth, Mckenna Ivy can be contacted via phone (618) 288-1480.Contact Information
Primary practice address
20 Professional Park Dr Ste B
Maryville IL 62062-5830
Phone: (618) 288-1480
Fax: (888) 718-4696
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Nursing Service Providers / General Practice | 163WG0000X | 041521566 | Illinois |
Profile Details
| NPI number | 1962158501 |
|---|---|
| LBN Legal business name | Shofroth, Mckenna Ivy |
| Credentials | Registered Nurse (RN) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 22nd, 2022 |
| Last updated | Feb 22nd, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1962158501 | NPPES |
| Illinois | MEDICAID | 1417916099 |
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