MEDICARE: MRS. KAREN A VERRILL NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	041233733	IL
2	363L00000X	Nurse Practitioner	209-D02959	IL

General Provider Information

NPI Number	:	1780684340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAREN A VERRILL NP

Provider Business Mailing Address
First Line	:	375 N WALL ST
Second Line	:
City	:	KANKAKEE
State	:	IL
Zip	:	60901-3483
Country	:	US
Telephone Number	:	815-933-9660
Fax Number	:	815-937-7968

Provider Business Practice Location Address
First Line	:	375 N. WALL STREET
Second Line	:
City	:	KANKAKEE
State	:	IL
Zip	:	60901-7822
Country	:	US
Telephone Number	:	815-933-9660
Fax Number	:	815-937-7968

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	03/29/2021

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