Healthcare Provider Details

I. General information

NPI: 1780619551
Provider Name (Legal Business Name): KELLY DELANEY COYNE RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHILDRENS PLZ BOX 30
CHICAGO IL
60614-3363
US

IV. Provider business mailing address

4145 WOLF RD
WESTERN SPRINGS IL
60558-1451
US

V. Phone/Fax

Practice location:
  • Phone: 773-975-8643
  • Fax: 773-880-3019
Mailing address:
  • Phone: 708-784-3423
  • Fax: 773-880-3019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0218X
TaxonomyPediatric Oncology Registered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: