Active NPI
Johnel Vercellino, RN
- Registered Nurse
- Christopher, IL
National Provider Identifier
1497424824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 041496464
- Practice address
- 4241 Highway 14 W
Christopher, IL 62822-1037 - Phone
- (618) 724-1684
- NPI assigned
- Sep 9, 2021
- Last updated
- Sep 9, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 041496464 | IL | Primary |
Addresses
Primary practice location
4241 Highway 14 W
Christopher, IL 62822-1037
Mailing address
1564 S Washington St
Du Quoin, IL 62832-3849
Phone (618) 542-8702
Other names 1
- Johnel Eubanks
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041496464 | IL | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1631145600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631145600000",
"number": "1497424824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1564 S WASHINGTON ST",
"city": "DU QUOIN",
"state": "IL",
"postal_code": "628323849",
"telephone_number": "618-542-8702"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4241 HIGHWAY 14 W",
"city": "CHRISTOPHER",
"state": "IL",
"postal_code": "628221037",
"telephone_number": "618-724-1684"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VERCELLINO",
"first_name": "JOHNEL",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-09",
"last_updated": "2021-09-09",
"certification_date": "2021-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "IL",
"license": "041496464",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JOHNEL",
"last_name": "EUBANKS",
"credential": "RN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Christopher, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.