Provider Demographics
NPI:1457544389
Name:KIRCHNER, MARSHA R (CF-NP)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:R
Last Name:KIRCHNER
Suffix:
Gender:F
Credentials:CF-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 N PROMENADE ST
Mailing Address - Street 2:P O BOX 530
Mailing Address - City:HAVANA
Mailing Address - State:IL
Mailing Address - Zip Code:62644-1243
Mailing Address - Country:US
Mailing Address - Phone:309-543-6600
Mailing Address - Fax:309-543-2089
Practice Address - Street 1:615 N PROMENADE ST
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:IL
Practice Address - Zip Code:62644-1243
Practice Address - Country:US
Practice Address - Phone:309-543-6600
Practice Address - Fax:309-543-2089
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006708363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL143457Medicare Oscar/Certification