Healthcare Provider Details

I. General information

NPI: 1366840407
Provider Name (Legal Business Name): BEVERLY WENDELL MS, RN, GCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SPALDING DR SUITE 111
NAPERVILLE IL
60540-6508
US

IV. Provider business mailing address

120 SPALDING DRIVE SUITE 111
NAPERVILLE IL
60540
US

V. Phone/Fax

Practice location:
  • Phone: 630-646-6118
  • Fax:
Mailing address:
  • Phone: 630-646-6118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number209004755
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: