Provider Demographics
NPI:1063957942
Name:INCE, ROSEMARY
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:INCE
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 1:211 FULTON ST. SUITE 207
Mailing Address - Street 2:ONE TECHNOLOGY PLAZA
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602
Mailing Address - Country:US
Mailing Address - Phone:309-671-8771
Mailing Address - Fax:
Practice Address - Street 1:211 FULTON ST. SUITE 207
Practice Address - Street 2:ONE TECHNOLOGY PLAZA
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602
Practice Address - Country:US
Practice Address - Phone:309-671-8771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041367190163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse