Individual
KIMBERLY NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
3880 SALEM LAKE DR STE F, LONG GROVE, IL 60047-5292
(847) 719-2220
(847) 719-2265
Mailing address
3880 SALEM LAKE DR STE F, LONG GROVE, IL 60047-5292
(847) 719-2220
(847) 719-2265
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209012143
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209012143
—
IL
Enumeration date
11/06/2014
Last updated
03/07/2023
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