Provider Demographics
NPI:1356794317
Name:FILLMORE, YVONNE (ANP)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:FILLMORE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 198
Mailing Address - Street 2:
Mailing Address - City:OQUAWKA
Mailing Address - State:IL
Mailing Address - Zip Code:61469-0198
Mailing Address - Country:US
Mailing Address - Phone:309-924-2414
Mailing Address - Fax:
Practice Address - Street 1:1204 HIGHWAY 164 E
Practice Address - Street 2:PO BOX 198
Practice Address - City:OQUAWKA
Practice Address - State:IL
Practice Address - Zip Code:61469-6146
Practice Address - Country:US
Practice Address - Phone:309-867-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041425493363LP0808X
IAA128192363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health