Healthcare Provider Details

I. General information

NPI: 1477818557
Provider Name (Legal Business Name): KATHLEEN OMEROD APN CCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN M FARLEY

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SPALDING DR STE 205
NAPERVILLE IL
60540-6527
US

IV. Provider business mailing address

1860 PAYSPHERE CIR
CHICAGO IL
60674-0018
US

V. Phone/Fax

Practice location:
  • Phone: 630-646-6022
  • Fax: 630-527-6400
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number209001704
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code364SX0200X
TaxonomyOncology Clinical Nurse Specialist
License Number209001704
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: