Healthcare Provider Details

I. General information

NPI: 1871128686
Provider Name (Legal Business Name): KIMBERLY ROSSI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1S450 SUMMIT AVE STE 165
OAKBROOK TERRACE IL
60181-3952
US

IV. Provider business mailing address

1319 N WOOD ST APT 3C
CHICAGO IL
60622-1184
US

V. Phone/Fax

Practice location:
  • Phone: 630-320-6871
  • Fax: 630-385-0026
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209021025
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: