Healthcare Provider Details

I. General information

NPI: 1356480933
Provider Name (Legal Business Name): MICHEALENE M REDEMSKE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16532 OAK PARK AVE SUITE 101
TINLEY PARK IL
60477-1918
US

IV. Provider business mailing address

119 CENTER RD
FRANKFORT IL
60423-1503
US

V. Phone/Fax

Practice location:
  • Phone: 708-429-2220
  • Fax:
Mailing address:
  • Phone: 815-464-6276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.006458
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: