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NPI Code Detail

MEDICARE: KELLY CANERDAY FNP-BC

MEDICARE: KELLY CANERDAY 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
1363LF0000XFamily Nurse Practitioner209010147IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1F400219797OTHERILMEDICARE PTAN

General Provider Information

NPI Number : 1952744963
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY CANERDAY FNP-BC
Provider Business Mailing Address
First Line : 40 75TH ST STE 1630
Second Line :
City : WILLOWBROOK
State : IL
Zip : 60527-2325
Country : US
Telephone Number : 630-581-5372
Fax Number :
Provider Business Practice Location Address
First Line : 40 75TH ST STE 1630
Second Line :
City : WILLOWBROOK
State : IL
Zip : 60527-2325
Country : US
Telephone Number : 630-581-5372
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2013
Last Update Date : 06/28/2021

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Directions to “ KELLY CANERDAY FNP-BC” Practice Location

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