Healthcare Provider Details

I. General information

NPI: 1477481299
Provider Name (Legal Business Name): KELLY LYNN GOERICH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NWM (NORTHWESTERN MEDICINE) - UROLOGY DPT 302 RANDALL RD # 206
GENEVA IL
60134
US

IV. Provider business mailing address

302 RANDALL RD #206
GENEVA IL
60134
US

V. Phone/Fax

Practice location:
  • Phone: 331-732-4600
  • Fax: 331-732-4602
Mailing address:
  • Phone: 331-732-4600
  • Fax: 331-732-4602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.378981
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: