Healthcare Provider Details

I. General information

NPI: 1548771595
Provider Name (Legal Business Name): NICOLE M WARE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 W OGDEN AVE APT 258
NAPERVILLE IL
60563-2932
US

IV. Provider business mailing address

1121 W OGDEN AVE APT 258
NAPERVILLE IL
60563-2932
US

V. Phone/Fax

Practice location:
  • Phone: 308-815-6806
  • Fax: 773-276-6668
Mailing address:
  • Phone: 630-881-5680
  • Fax: 773-276-6668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.016771
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number041.331782
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: