Healthcare Provider Details

I. General information

NPI: 1730093360
Provider Name (Legal Business Name): KERI VILLARREAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 EAGLE ST
JOLIET IL
60432-2031
US

IV. Provider business mailing address

1201 EAGLE ST
JOLIET IL
60432-2031
US

V. Phone/Fax

Practice location:
  • Phone: 708-243-2636
  • Fax: 708-202-7975
Mailing address:
  • Phone: 708-243-2636
  • Fax: 708-202-7975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number041407069
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: