Healthcare Provider Details

I. General information

NPI: 1093312977
Provider Name (Legal Business Name): JULIE A GRANDOLFO FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 RYAN PKWY
ALGONQUIN IL
60102-4527
US

IV. Provider business mailing address

1340 RYAN PKWY
ALGONQUIN IL
60102-4527
US

V. Phone/Fax

Practice location:
  • Phone: 815-477-7350
  • Fax: 815-477-7351
Mailing address:
  • Phone: 815-477-7350
  • Fax: 815-477-7351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209022068
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209022068
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: