Provider Demographics
NPI:1619692118
Name:FORNOFF, YVONNE LYNN (BSN, RN, CCM)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:LYNN
Last Name:FORNOFF
Suffix:
Gender:F
Credentials:BSN, RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7619 NCR 32
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:IL
Mailing Address - Zip Code:62644-6264
Mailing Address - Country:US
Mailing Address - Phone:309-215-8213
Mailing Address - Fax:866-260-8572
Practice Address - Street 1:7619 NCR 32
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:IL
Practice Address - Zip Code:62644-6264
Practice Address - Country:US
Practice Address - Phone:309-215-8213
Practice Address - Fax:866-260-8572
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.299119163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management