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NPI Code Detail

MEDICARE: MRS. ELLEN DEKOLD APN

MEDICARE: MRS. ELLEN DEKOLD APN
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
1363L00000XNurse Practitioner209.019486IL

General Provider Information

NPI Number : 1316571151
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELLEN DEKOLD APN
Provider Business Mailing Address
First Line : 11750 WINDING TRAILS DR
Second Line :
City : WILLOW SPRINGS
State : IL
Zip : 60480-1191
Country : US
Telephone Number : 630-432-9830
Fax Number :
Provider Business Practice Location Address
First Line : 1S072 LUTHER AVE
Second Line :
City : LOMBARD
State : IL
Zip : 60148-4164
Country : US
Telephone Number : 630-247-8877
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2020
Last Update Date : 03/02/2020

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