Individual
LOGAN KLOCKNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8201 E RIVERSIDE BLVD, ROCKFORD, IL 61114-2300
(815) 971-7000
Mailing address
2400 N ROCKTON AVE, ROCKFORD, IL 61103-3655
(815) 971-5000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041366252
IL
363L00000X
Nurse Practitioner
Primary
209022924
IL
Other
Enumeration date
02/22/2021
Last updated
02/26/2021
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