Individual
SHANNON ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
722 N 11TH ST, MURPHYSBORO, IL 62966-1602
(618) 353-4445
Mailing address
722 N 11TH ST, MURPHYSBORO, IL 62966-1602
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043104818
IL
Other
Enumeration date
02/14/2017
Last updated
02/14/2017
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