Healthcare Provider Details

I. General information

NPI: 1831114933
Provider Name (Legal Business Name): CONI NIELSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 01/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SPALDING DR STE 400
NAPERVILLE IL
60540-6550
US

IV. Provider business mailing address

1860 PAYSPHERE CIR
CHICAGO IL
60674-0018
US

V. Phone/Fax

Practice location:
  • Phone: 630-718-2660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209005567
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: