Provider Demographics
NPI:1710975891
Name:CAPRIOLA, KATHLEEN D (APN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:D
Last Name:CAPRIOLA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 ROXBURY RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5089
Mailing Address - Country:US
Mailing Address - Phone:815-227-8300
Mailing Address - Fax:815-227-8301
Practice Address - Street 1:612 ROXBURY RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5089
Practice Address - Country:US
Practice Address - Phone:815-227-8300
Practice Address - Fax:815-227-8301
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003505364SA2200X
IL041258611163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00605030OtherRAILROAD MEDICARE
IL1616108OtherBCBS
ILK18445Medicare PIN
IL211215Medicare PIN
IL1616108OtherBCBS
IL216528004Medicare PIN