Backroad Health Care
Organization Active NPI Family Nurse Practitioner · Walnut Hill, IL
NPI 1467857086 · NPPES record last updated Oct 24, 2014
Key facts
- NPI
- 1467857086
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 209010715 (IL)
- Legal business name
- BACKROAD HEALTH CARE
- Practice address
- 7825A East Grant Road
Walnut Hill, IL 62893 - Phone
- (618) 545-0707
- NPI assigned
- Oct 24, 2014
- Organization subpart
- No
Authorized official
- Name
- Paul Havrilka, APN, FNP-C
- Title
- Owner/Provider
- Phone
- (618) 545-0707
National Provider Directory
Locations
7825 E Grant Rd
Walnut Hill, IL 62893
Phone (618) 545-0707
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | 209010715 | IL | Yes |
Addresses
Primary practice location
7825A East Grant Road
Walnut Hill, IL 62893
Mailing address
7825A East Grant Road
Walnut Hill, IL 62893
Phone (618) 545-0707
Other providers in Walnut Hill, IL
All providers in Walnut Hill, IL · Family Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.