Healthcare Provider Details

I. General information

NPI: 1093313249
Provider Name (Legal Business Name): KIMBERLY RESCHKE BSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2020
Last Update Date: 10/10/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N STRATFORD RD
ARLINGTON HEIGHTS IL
60004-5835
US

IV. Provider business mailing address

711 N STRATFORD RD
ARLINGTON HEIGHTS IL
60004-5835
US

V. Phone/Fax

Practice location:
  • Phone: 312-860-8023
  • Fax:
Mailing address:
  • Phone: 312-860-8023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number041.413065
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: