Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
KENDRA MICKELSON
Active Sole ProprietorSkilled Nursing Facility · EUREKA, IL
Registration Details
- NPI Number
- 1992158356
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Jul 20, 2016 (9.7536897593695 yrs)
- Last Updated
- Jul 20, 2016
- Licenses
-
0042424 (IL)1694647 (IL)
- Sole Proprietor
- Yes
Practice Information
- Address
-
700 N MAIN STEUREKA, IL, 615301085Browse IL providers · Browse ZIP 61530
- Phone
- 3094679094
- Fax
- 3094679011
- Primary Specialty
-
Skilled Nursing Facility
314000000X
- Additional Specialty
- Skilled Nursing Facility
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.