MEDICARE: JOY KLUBER 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
1	363LF0000X	Family Nurse Practitioner	209010755	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041351656	OTHER	IL	RN
2	209010755	OTHER	IL	APN

General Provider Information

NPI Number	:	1750703716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOY KLUBER APN

Provider Business Mailing Address
First Line	:	16310 S LINCOLN HWY
Second Line	:
City	:	PLAINFIELD
State	:	IL
Zip	:	60586-9006
Country	:	US
Telephone Number	:	815-782-8440
Fax Number	:	815-926-5305

Provider Business Practice Location Address
First Line	:	16310 S LINCOLN HWY
Second Line	:
City	:	PLAINFIELD
State	:	IL
Zip	:	60586-9006
Country	:	US
Telephone Number	:	815-782-8440
Fax Number	:	815-926-5305

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

Provider Enumeration Date	:	01/10/2014
Last Update Date	:	07/07/2020

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