Basic Information
| Provider Information | |||||||||
| NPI: | 1669192837 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCROGGINS | ||||||||
| FirstName: | CASSIE | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | REGISTERED NURSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 509 S COLLEGE ST | ||||||||
| Address2: | |||||||||
| City: | STAUNTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620881867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2176021867 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 393 E EDWARDSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | WOOD RIVER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620951646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182594111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2022 | ||||||||
| LastUpdateDate: | 08/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WI0600X | 041418678 | IL | Y | Nursing Service Providers | Registered Nurse | Infection Control |
No ID Information.