Individual
MRS. CHENIN LEE CONGRAVE RUDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
345 EXECUTIVE PKWY STE M4, ROCKFORD, IL 61107-5291
(815) 381-8514
(815) 381-8665
Mailing address
345 EXECUTIVE PKWY STE M4, ROCKFORD, IL 61107-5291
(815) 381-8514
(815) 381-8665
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041388930
IL
363LA2100X
Acute Care Nurse Practitioner
Primary
209017674
IL
Other
Enumeration date
05/18/2018
Last updated
06/16/2018
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