Provider Demographics
NPI:1497377865
Name:MAUCH, KOREN (RN)
Entity Type:Individual
Prefix:MS
First Name:KOREN
Middle Name:
Last Name:MAUCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 FRANTUM RD
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-8909
Mailing Address - Country:US
Mailing Address - Phone:815-501-6147
Mailing Address - Fax:
Practice Address - Street 1:718 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-2227
Practice Address - Country:US
Practice Address - Phone:815-899-8223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041306039163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool