Healthcare Provider Details

I. General information

NPI: 1801696679
Provider Name (Legal Business Name): KIERSTEN NORDLI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 W RANDOLPH ST
CHICAGO IL
60607-1619
US

IV. Provider business mailing address

1123 W RANDOLPH ST
CHICAGO IL
60607-1657
US

V. Phone/Fax

Practice location:
  • Phone: 312-622-5500
  • Fax:
Mailing address:
  • Phone: 312-620-7870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.031571
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: