Healthcare Provider Details

I. General information

NPI: 1508401175
Provider Name (Legal Business Name): CHRISTINE N PONTARELLI APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS CHRISTINE S NELSON

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 WEAVER PKWY
WARRENVILLE IL
60555-3269
US

IV. Provider business mailing address

4405 WEAVER PKWY
WARRENVILLE IL
60555-3269
US

V. Phone/Fax

Practice location:
  • Phone: 630-352-5450
  • Fax: 630-352-5499
Mailing address:
  • Phone: 630-352-5450
  • Fax: 630-352-5499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209019570
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209019570
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: