Provider Demographics
NPI:1689881518
Name:ESCARILLA, KATRINA G (RN, APN,CNP)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:G
Last Name:ESCARILLA
Suffix:
Gender:F
Credentials:RN, APN,CNP
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:GECOS
Other - Last Name:ESCARILLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN,APN,CNP
Mailing Address - Street 1:1441 BRANDING AVENUE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515
Mailing Address - Country:US
Mailing Address - Phone:312-609-0300
Mailing Address - Fax:
Practice Address - Street 1:1441 BRANDING AVENUE
Practice Address - Street 2:SUITE 310
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515
Practice Address - Country:US
Practice Address - Phone:312-609-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-286691163W00000X
IL209006348363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1316998578OtherGROUP PRACTICE NPI