Healthcare Provider Details

I. General information

NPI: 1356614796
Provider Name (Legal Business Name): KRISTINE LYNETTE MONTERO NICHOLS APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINE LYNETTE MONTERO NICHOLS

II. Dates (important events)

Enumeration Date: 02/15/2012
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 N YORK ST
ELMHURST IL
60126-1607
US

IV. Provider business mailing address

755 N YORK ST
ELMHURST IL
60126-1607
US

V. Phone/Fax

Practice location:
  • Phone: 630-527-3645
  • Fax: 331-221-3883
Mailing address:
  • Phone: 630-527-3645
  • Fax: 331-221-3883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209009118
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209009118
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: