Healthcare Provider Details

I. General information

NPI: 1295025443
Provider Name (Legal Business Name): KRISTY AMORE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1083 E LAKE COOK RD
WHEELING IL
60090-2502
US

IV. Provider business mailing address

601 SKOKIE BLVD STE 400
NORTHBROOK IL
60062-2820
US

V. Phone/Fax

Practice location:
  • Phone: 847-808-7070
  • Fax: 847-808-7474
Mailing address:
  • Phone: 847-562-1410
  • Fax: 847-562-0830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number209006194
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: