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General NPI Number Information
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NPI Number | 1386565463
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Entity Type | Individual
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Provider Name | AVA GBRIELLA CAPOGRECO LPN
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Gender | Female
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Dates
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Enumeration Date | 07/23/2026
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Last Update Date | 07/23/2026
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Provider Practice Location Address
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Address Line | 11531 SUNDERLAND RD
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City | MARION
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State | IL
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Zip | 62959-8274
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Country | US
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Telephone | 618-964-5139
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Fax |
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Provider Business Mailing Address
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Address Line | 11693 SOUTHPOINT LN
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City | WEST FRANKFORT
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State | IL
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Zip | 62896-4905
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Country | US
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Telephone | 618-889-1321
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 043616138
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License Number State | IL
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