Individual
SANDRA KINNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
202 W PARK AVE, CHAMPAIGN, IL 61820-3929
(217) 373-2430
Mailing address
1813 STRATFORD DR, CHAMPAIGN, IL 61821-5706
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
43080695
IL
Other
Enumeration date
05/21/2007
Last updated
07/08/2007
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