Provider Demographics
NPI:1780684340
Name:VERRILL, KAREN A (NP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:A
Last Name:VERRILL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 N WALL ST
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3483
Mailing Address - Country:US
Mailing Address - Phone:815-933-9660
Mailing Address - Fax:815-937-7968
Practice Address - Street 1:375 N. WALL STREET
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-7822
Practice Address - Country:US
Practice Address - Phone:815-933-9660
Practice Address - Fax:815-937-7968
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041233733163W00000X
IL209-D02959363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
S93675Medicare UPIN
ILK08006Medicare ID - Type Unspecified