Provider Demographics
NPI:1396333928
Name:DEFFENBAUGH, SHARON MINDY
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:MINDY
Last Name:DEFFENBAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LACON
Mailing Address - State:IL
Mailing Address - Zip Code:61540-1737
Mailing Address - Country:US
Mailing Address - Phone:309-363-4695
Mailing Address - Fax:
Practice Address - Street 1:815 2ND ST
Practice Address - Street 2:
Practice Address - City:LACON
Practice Address - State:IL
Practice Address - Zip Code:61540-1737
Practice Address - Country:US
Practice Address - Phone:309-363-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider