Healthcare Provider Details

I. General information

NPI: 1154427193
Provider Name (Legal Business Name): NORA GUMAYAGAY KADOLPH APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 FLETCHER DR STE 305
ELGIN IL
60123-4756
US

IV. Provider business mailing address

750 FLETCHER DR STE 305
ELGIN IL
60123-4756
US

V. Phone/Fax

Practice location:
  • Phone: 847-742-3333
  • Fax: 847-742-3070
Mailing address:
  • Phone: 847-742-3333
  • Fax: 847-742-9070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-004307
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: