Healthcare Provider Details

I. General information

NPI: 1023888633
Provider Name (Legal Business Name): JAMES KERRIDGE DNP, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S DAMEN AVE
CHICAGO IL
60612-3728
US

IV. Provider business mailing address

820 S. DAMEN AVE. TAYLOR BUILDING, ROOM 5211
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-539-0163
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number041.336102
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: