Provider Demographics
NPI:1932950003
Name:IGLEHART, KIRSTIN ANNE (RN)
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:ANNE
Last Name:IGLEHART
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 1:415 N ELLIOTT ST
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-3615
Mailing Address - Country:US
Mailing Address - Phone:618-843-4338
Mailing Address - Fax:618-392-7225
Practice Address - Street 1:363 N WEST ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-1160
Practice Address - Country:US
Practice Address - Phone:618-392-9400
Practice Address - Fax:618-392-7225
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041433706163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care