Individual
KATHLEEN AVERILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
209-004900
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209-004900
CNP LICENSE
IL
01
—
6134
BOARD OF NURSING
MN
Enumeration date
10/25/2007
Last updated
01/04/2019
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