Healthcare Provider Details

I. General information

NPI: 1144264649
Provider Name (Legal Business Name): KELLY S FINKBEINER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

4922 W GRACE ST
CHICAGO IL
60641-3505
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-4210
  • Fax:
Mailing address:
  • Phone: 773-315-2383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209-004677
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: