Provider Demographics
NPI:1629135587
Name:NEUKIRCH, ARMINDA JEAN
Entity Type:Individual
Prefix:
First Name:ARMINDA
Middle Name:JEAN
Last Name:NEUKIRCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ARMINDA
Other - Middle Name:JEAN
Other - Last Name:SORRELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:402 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:MARENGO
Mailing Address - State:IL
Mailing Address - Zip Code:60152-3566
Mailing Address - Country:US
Mailing Address - Phone:815-568-2996
Mailing Address - Fax:
Practice Address - Street 1:1219 BLACKHAWK AVE
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60051-9326
Practice Address - Country:US
Practice Address - Phone:815-385-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL43085426164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse