MEDICARE: NICOLE KEDZIE CPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife

General Provider Information

NPI Number	:	1447821558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE KEDZIE CPM

Provider Business Mailing Address
First Line	:	1818 QUAIL HOLLOW RD
Second Line	:
City	:	STEWARD
State	:	IL
Zip	:	60553-9775
Country	:	US
Telephone Number	:	630-802-1869
Fax Number	:

Provider Business Practice Location Address
First Line	:	1818 QUAIL HOLLOW RD
Second Line	:
City	:	STEWARD
State	:	IL
Zip	:	60553-9775
Country	:	US
Telephone Number	:	630-802-1869
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2021
Last Update Date	:	07/08/2021

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Directions to “ NICOLE KEDZIE CPM” Practice Location

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