Healthcare Provider Details

I. General information

NPI: 1548670136
Provider Name (Legal Business Name): KELLY EDWARDS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 N ELM ST SUITE 109
HINSDALE IL
60521-3635
US

IV. Provider business mailing address

908 N ELM ST SUITE 109
HINSDALE IL
60521-3635
US

V. Phone/Fax

Practice location:
  • Phone: 630-794-9999
  • Fax: 630-794-9998
Mailing address:
  • Phone: 630-794-9999
  • Fax: 630-794-9998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number041.340806
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: