Healthcare Provider Details

I. General information

NPI: 1720816382
Provider Name (Legal Business Name): KELLY ANNE GARDYNSKI DNP, APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S RANDALL RD STE 220
ALGONQUIN IL
60102-5937
US

IV. Provider business mailing address

600 S RANDALL RD STE 220
ALGONQUIN IL
60102-5937
US

V. Phone/Fax

Practice location:
  • Phone: 847-854-9402
  • Fax:
Mailing address:
  • Phone: 847-854-9402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209.030113
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: