Provider Demographics
NPI:1396912366
Name:PADILLA, JOSEPH (RN)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:PADILLA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 AMBERLEIGH DR
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-4088
Mailing Address - Country:US
Mailing Address - Phone:815-293-3290
Mailing Address - Fax:
Practice Address - Street 1:128 AMBERLEIGH DR
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-4088
Practice Address - Country:US
Practice Address - Phone:815-293-3290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.319803163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse