Healthcare Provider Details

I. General information

NPI: 1316506082
Provider Name (Legal Business Name): JANEY EDEN KOTTLER DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7298
  • Fax:
Mailing address:
  • Phone: 312-996-7298
  • Fax: 312-413-0289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.474969
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.019525
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: