Healthcare Provider Details

I. General information

NPI: 1982938106
Provider Name (Legal Business Name): MICHELLE E NELLETT APN, MSN, CCRN, CCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-6359
  • Fax: 708-684-1983
Mailing address:
  • Phone: 708-684-6359
  • Fax: 708-684-1983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number209.005772
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: