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NPI Code Detail

MEDICARE: NICOLE KLEES

MEDICARE: NICOLE KLEES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1003537986
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE KLEES
Provider Business Mailing Address
First Line : 7101 N CICERO AVE STE 202
Second Line :
City : LINCOLNWOOD
State : IL
Zip : 60712-2143
Country : US
Telephone Number : 773-433-6210
Fax Number : 866-744-0950
Provider Business Practice Location Address
First Line : 2409 N CLYBOURN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60614-6185
Country : US
Telephone Number : 773-433-6210
Fax Number : 866-744-0950
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2022
Last Update Date : 09/08/2022

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Directions to “ NICOLE KLEES ” Practice Location

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