Healthcare Provider Details

I. General information

NPI: 1982387304
Provider Name (Legal Business Name): NANCY A KURILLA MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#1 HAIRPIN DRIVE
EDWARDSVILLE IL
62026-0001
US

IV. Provider business mailing address

9008 E MILL CREEK RD
TROY IL
62294-2712
US

V. Phone/Fax

Practice location:
  • Phone: 618-650-5024
  • Fax:
Mailing address:
  • Phone: 618-650-5024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number041243790
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: