Individual
MRS. VIRGINIA KATHERINE HOUSE HATHCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
4789 ROUTE 71, OSWEGO, IL 60543-7415
(630) 692-5730
(630) 692-5731
Mailing address
611 W. PARK ST., BWPC, URBANA, IL 61801-2500
(217) 383-6792
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209011936
IL
363LF0000X
Family Nurse Practitioner
1-121553
AL
363LF0000X
Family Nurse Practitioner
209.011936
IL
Other
Enumeration date
03/13/2012
Last updated
02/11/2020
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