Healthcare Provider Details

I. General information

NPI: 1942578794
Provider Name (Legal Business Name): KELLY S. DRUDI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 GALWAY DR
AURORA IL
60505-1100
US

IV. Provider business mailing address

1560 GALWAY DR
AURORA IL
60505-1100
US

V. Phone/Fax

Practice location:
  • Phone: 630-569-4236
  • Fax: 331-472-2964
Mailing address:
  • Phone: 630-569-4236
  • Fax: 331-472-2964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number277.000534
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: