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General NPI Number Information
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NPI Number | 1861032245
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Entity Type | Individual
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Provider Name | KENNETH DALE RESTOR APRN
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Gender | Male
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Dates
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Enumeration Date | 01/13/2020
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Last Update Date | 01/13/2020
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Provider Practice Location Address
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Address Line | 15 SPINNING WHEEL RD STE 30
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City | HINSDALE
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State | IL
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Zip | 60521-7651
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Country | US
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Telephone | 630-259-1515
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Fax |
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Provider Business Mailing Address
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Address Line | 8053 KOLMAR AVE
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City | SKOKIE
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State | IL
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Zip | 60076-3114
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Country | US
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Telephone | 847-558-9852
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209020225
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License Number State | IL
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