Provider Demographics
NPI:1306641808
Name:GOERSCH, SHANDRA DAWN (MSN, RN)
Entity type:Individual
Prefix:MRS
First Name:SHANDRA
Middle Name:DAWN
Last Name:GOERSCH
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 W MONROE ST
Mailing Address - Street 2:
Mailing Address - City:HECKER
Mailing Address - State:IL
Mailing Address - Zip Code:62248-1118
Mailing Address - Country:US
Mailing Address - Phone:618-978-3973
Mailing Address - Fax:
Practice Address - Street 1:6 HAIRPIN DR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62026-1000
Practice Address - Country:US
Practice Address - Phone:618-650-3956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041354859163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse