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Individual

ANTHONY ENRICO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
5666 E STATE ST, ROCKFORD, IL 61108-2425
(815) 226-2000
Mailing address
1911 RIDGELAND RD, ROCKFORD, IL 61108-6321
(815) 713-8107

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041442697
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209023436
IL

Other

Enumeration date
05/04/2021
Last updated
12/28/2021
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