Healthcare Provider Details

I. General information

NPI: 1437068723
Provider Name (Legal Business Name): ADVANCED PRACTICE MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 ELM ST
PARK FOREST IL
60466-1702
US

IV. Provider business mailing address

29 ELM ST
PARK FOREST IL
60466-1702
US

V. Phone/Fax

Practice location:
  • Phone: 773-610-9058
  • Fax:
Mailing address:
  • Phone: 773-610-9058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIONIE ABRAHAM
Title or Position: OWNER
Credential:
Phone: 773-610-9058