Healthcare Provider Details

I. General information

NPI: 1780684340
Provider Name (Legal Business Name): KAREN A VERRILL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 N. WALL STREET
KANKAKEE IL
60901-7822
US

IV. Provider business mailing address

375 N WALL ST
KANKAKEE IL
60901-3483
US

V. Phone/Fax

Practice location:
  • Phone: 815-933-9660
  • Fax: 815-937-7968
Mailing address:
  • Phone: 815-933-9660
  • Fax: 815-937-7968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041233733
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209-D02959
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: