Healthcare Provider Details

I. General information

NPI: 1194718742
Provider Name (Legal Business Name): JOSEPHINE N. MCCASKILL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 10/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3153 E BENDING CREEK TRL
CRETE IL
60417-3861
US

IV. Provider business mailing address

3153 E BENDING CREEK TRL PO BOX 545
CRETE IL
60417-3861
US

V. Phone/Fax

Practice location:
  • Phone: 773-640-7944
  • Fax:
Mailing address:
  • Phone: 773-640-7944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number209004940
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number209004940
License Number StateIL

VIII. Authorized Official

Name: JOSEPHINE MCCASKILL
Title or Position: FAMILY NURSE PRACTITIONER
Credential: NP
Phone: 773-640-7944