Healthcare Provider Details

I. General information

NPI: 1619829223
Provider Name (Legal Business Name): NICOLE NEWTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2026
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1226 S WESTERN AVE
PARK RIDGE IL
60068-5058
US

IV. Provider business mailing address

1226 S WESTERN AVE
PARK RIDGE IL
60068-5058
US

V. Phone/Fax

Practice location:
  • Phone: 630-338-2708
  • Fax:
Mailing address:
  • Phone: 630-338-2708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209034717
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: