Doctor Name: | LAURA CASTILLO |
NPI Number: | 1275905374 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | 209.013327 |
Business Practice Address: | 7 S Hospital Dr Murphysboro, IL - 629663333 |
Business Phone Number: | 6186873418 |
Business Fax Number: | 6186871859 |
Mailing Address: | 109 California Street, Po Box 577 CARTERVILLE |
State: | IL |
Postal Code: | 629180577 |
Phone Number: | 6189858221 |
Fax Number: | 6189854635 |
NPI Enumeration Date: | 10/28/2015 |
NPI Last Update Date: | 10/28/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 209.013327 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |