MEDICARE: KRISTIN SIMERDLA DOYLE NP-C

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
1	363LF0000X	Family Nurse Practitioner	209014971	IL

General Provider Information

NPI Number	:	1255874335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN SIMERDLA DOYLE NP-C

Provider Business Mailing Address
First Line	:	7270 W. COLLEGE DR
Second Line	:	STE 102
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463
Country	:	US
Telephone Number	:	708-603-5980
Fax Number	:	708-589-9059

Provider Business Practice Location Address
First Line	:	7270 W. COLLEGE DR. STE 102
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1287
Country	:	US
Telephone Number	:	708-603-5980
Fax Number	:	708-589-9059

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2016
Last Update Date	:	12/13/2021

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