Healthcare Provider Details

I. General information

NPI: 1275730574
Provider Name (Legal Business Name): JANE PELOSI-KELLY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANE M PELOSI-KELLY

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 E BRUSH HILL RD
ELMHURST IL
60126-5658
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 331-221-0096
  • Fax: 331-221-3718
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209003572
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number277004198
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277004198
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: