Provider Demographics
NPI:1942319124
Name:O'NEILL, KAROL RUTH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KAROL
Middle Name:RUTH
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N BURR BLVD
Mailing Address - Street 2:
Mailing Address - City:KEWANEE
Mailing Address - State:IL
Mailing Address - Zip Code:61443-2214
Mailing Address - Country:US
Mailing Address - Phone:309-852-0197
Mailing Address - Fax:
Practice Address - Street 1:110 N BURR BLVD
Practice Address - Street 2:
Practice Address - City:KEWANEE
Practice Address - State:IL
Practice Address - Zip Code:61443-2214
Practice Address - Country:US
Practice Address - Phone:309-852-5272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL200041991207Q00000X
IL209004438363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208011Medicare ID - Type Unspecified
ILP75777Medicare UPIN