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General NPI Number Information
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NPI Number | 1609407329
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Entity Type | Individual
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Provider Name | KELLI MARIE CASTRO APRN, AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/31/2020
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Last Update Date | 03/13/2023
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Provider Practice Location Address
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Address Line | 1725 W HARRISON ST
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City | CHICAGO
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State | IL
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Zip | 60612-3841
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Country | US
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Telephone | 309-945-8218
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Fax |
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Provider Business Mailing Address
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Address Line | 2925 TYLER CT
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City | WOODRIDGE
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State | IL
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Zip | 60517-1009
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Country | US
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Telephone | 309-945-8218
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | AP144847
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 209020949
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License Number State | IL
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