Healthcare Provider Details

I. General information

NPI: 1437168374
Provider Name (Legal Business Name): JOSEPHINE NOELLA MCCASKILL APN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 11/04/2019
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

42592 CLOVER HILL RD
HOLLYWOOD MD
20636-2203
US

V. Phone/Fax

Practice location:
  • Phone: 301-968-5429
  • Fax:
Mailing address:
  • Phone: 301-968-5429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209004940
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: