Healthcare Provider Details

I. General information

NPI: 1720215783
Provider Name (Legal Business Name): KELLY E. RIMAWI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 06/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10837 S CICERO AVE SUITE 200
OAK LAWN IL
60453-6458
US

IV. Provider business mailing address

5009 W 95TH ST
OAK LAWN IL
60453-2401
US

V. Phone/Fax

Practice location:
  • Phone: 708-636-7575
  • Fax: 708-636-6193
Mailing address:
  • Phone: 708-636-7575
  • Fax: 708-636-7193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.325954
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209007636
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: