Healthcare Provider Details

I. General information

NPI: 1093137952
Provider Name (Legal Business Name): APRIL FAAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: APRIL I UNDERWWOOD

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5666 E STATE ST
ROCKFORD IL
61108-2425
US

IV. Provider business mailing address

5666 E STATE ST
ROCKFORD IL
61108-2425
US

V. Phone/Fax

Practice location:
  • Phone: 815-886-2000
  • Fax: 815-227-2370
Mailing address:
  • Phone: 815-395-5380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number209011161
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: