Provider Demographics
NPI:1154782530
Name:OKAWVILLE FAMILY CARE LLC
Entity type:Organization
Organization Name:OKAWVILLE FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORRILL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:618-249-6203
Mailing Address - Street 1:206 EAST BELLEVILLE
Mailing Address - Street 2:
Mailing Address - City:OKAWVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62271
Mailing Address - Country:US
Mailing Address - Phone:618-243-1090
Mailing Address - Fax:618-243-1094
Practice Address - Street 1:207 E BELLEVILLE
Practice Address - Street 2:
Practice Address - City:OKAWVILLE
Practice Address - State:IL
Practice Address - Zip Code:62271
Practice Address - Country:US
Practice Address - Phone:618-243-1090
Practice Address - Fax:618-243-1094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty