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General NPI Number Information
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NPI Number | 1134856412
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Entity Type | Individual
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Provider Name | KARINA QUINTO VAZQUEZ FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/05/2022
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 2718 N PROSPECT AVE
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City | CHAMPAIGN
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State | IL
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Zip | 61822-1298
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Country | US
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Telephone | 217-337-3852
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Fax |
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Provider Business Mailing Address
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Address Line | 1006 CAMBRIDGE DR
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City | RANTOUL
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State | IL
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Zip | 61866-1202
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Country | US
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Telephone | 217-390-1479
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209025089
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License Number State | IL
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