NPI 1023281847

Paula R Icenogle

Practitioner Driver Colchester, IL

Practice location

Address: 708 Sherry St, Colchester, IL 62326-1176
Phone: (309) 776-3978

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X Licence I25267678827 (IL)

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Registry record

NPI: 1023281847
Entity type: Individual
Sex (as registered): Female
NPI issued: 13 Apr 2008
Record last updated: 13 Apr 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.