Individual
KELLY MASULA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1147 S WABASH AVE STE 200, CHICAGO, IL 60605-2348
(312) 929-9191
Mailing address
0S553 FOREST ST, WINFIELD, IL 60190-1541
(858) 524-4414
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209027496
IL
Other
Enumeration date
12/19/2023
Last updated
12/19/2023
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