MEDICARE: KRISTINE M CAMPBELL FNP-BC

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	363L00000X	Nurse Practitioner	209034424	IL

General Provider Information

NPI Number	:	1649127150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINE M CAMPBELL FNP-BC

Provider Business Mailing Address
First Line	:	9000 S OAKLEY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-6430
Country	:	US
Telephone Number	:	708-745-0612
Fax Number	:

Provider Business Practice Location Address
First Line	:	9000 S OAKLEY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-6430
Country	:	US
Telephone Number	:	708-745-0612
Fax Number	:

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

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/13/2026

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