Provider Demographics
NPI:1760590319
Name:PRINDAVILLE, ANN SHEREE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:SHEREE
Last Name:PRINDAVILLE
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 1:604 E FELLOWS ST
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-2242
Mailing Address - Country:US
Mailing Address - Phone:815-288-7071
Mailing Address - Fax:
Practice Address - Street 1:325 ILLINOIS ROUTE 2
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021
Practice Address - Country:US
Practice Address - Phone:815-284-6611
Practice Address - Fax:815-284-6641
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health