Provider Demographics
NPI:1497424824
Name:VERCELLINO, JOHNEL (RN)
Entity Type:Individual
Prefix:
First Name:JOHNEL
Middle Name:
Last Name:VERCELLINO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JOHNEL
Other - Middle Name:
Other - Last Name:EUBANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1564 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-3849
Mailing Address - Country:US
Mailing Address - Phone:618-542-8702
Mailing Address - Fax:
Practice Address - Street 1:4241 HIGHWAY 14 W
Practice Address - Street 2:
Practice Address - City:CHRISTOPHER
Practice Address - State:IL
Practice Address - Zip Code:62822-1037
Practice Address - Country:US
Practice Address - Phone:618-724-1684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041496464163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse