Organization
BACKROAD HEALTH CARE
Active
Organization
BACKROAD HEALTH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL HAVRILKA APN, FNP-C (OWNER/PROVIDER)
(618) 545-0707
Entity
Organization
Contact information
Practice address
7825A EAST GRANT ROAD, WALNUT HILL, IL 62893
(618) 545-0707
Mailing address
7825A EAST GRANT ROAD, WALNUT HILL, IL 62893
(618) 545-0707
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209010715
IL
Other
Enumeration date
10/24/2014
Last updated
10/24/2014
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