Healthcare Provider Details

I. General information

NPI: 1093016842
Provider Name (Legal Business Name): KIMBERLY GOEHL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 N. WASHINGTON ST.
NAPERVILLE IL
60540
US

IV. Provider business mailing address

3 N WASHINGTON ST FL 2
NAPERVILLE IL
60540-4780
US

V. Phone/Fax

Practice location:
  • Phone: 630-357-6540
  • Fax: 630-357-6435
Mailing address:
  • Phone: 630-357-6540
  • Fax: 630-357-6435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209008170
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: