Individual
KELLIE VAIDYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
999 OAKMONT PLAZA DR STE 100, WESTMONT, IL 60559-1381
(630) 850-2120
Mailing address
215 HARRISON ST, OAK PARK, IL 60304-1533
(708) 207-2300
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041325823
IL
363L00000X
Nurse Practitioner
209016357
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209016357
IL
Other
Enumeration date
03/16/2017
Last updated
05/24/2024
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