Healthcare Provider Details

I. General information

NPI: 1194015172
Provider Name (Legal Business Name): KYLENE LAWLOR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E BUTTERFIELD RD # 297
ELMHURST IL
60126-5103
US

IV. Provider business mailing address

205 E BUTTERFIELD RD # 297
ELMHURST IL
60126-5103
US

V. Phone/Fax

Practice location:
  • Phone: 708-795-0100
  • Fax: 708-795-0101
Mailing address:
  • Phone: 708-795-0100
  • Fax: 708-795-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209.008763
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: