Healthcare Provider Details

I. General information

NPI: 1598284473
Provider Name (Legal Business Name): MARGARET KEARNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 HIGHLAND AVE
DOWNERS GROVE IL
60515-1500
US

IV. Provider business mailing address

3821 ARTHUR AVE
BROOKFIELD IL
60513-1555
US

V. Phone/Fax

Practice location:
  • Phone: 630-275-3599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number209.003128
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: