Healthcare Provider Details

I. General information

NPI: 1396097440
Provider Name (Legal Business Name): EDWARD HEALTH VENTURES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 W 95TH ST
NAPERVILLE IL
60564-9011
US

IV. Provider business mailing address

27555 DIEHL RD ENTRANCE B
WARRENVILLE IL
60555-3849
US

V. Phone/Fax

Practice location:
  • Phone: 630-646-3950
  • Fax: 630-548-6832
Mailing address:
  • Phone: 630-646-3950
  • Fax: 630-548-6832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. BILL KOTTMANN
Title or Position: PRESIDENT
Credential:
Phone: 630-646-3950