Individual
MRS. KATHERINE ROSE FORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1401 E 12TH ST, MENDOTA, IL 61342
(815) 343-1925
Mailing address
1401 E 12TH ST, MENDOTA, IL 61342-9216
(815) 539-1607
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
209-009634
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
041.328911
IL
Other
Enumeration date
08/03/2012
Last updated
03/04/2025
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