Individual
KIMBERLY NICOLE LAVELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7531 S STONY ISLAND AVE, CHICAGO, IL 60649-3954
(773) 947-7500
Mailing address
231 E FREMONT AVE, APT 104, ELMHURST, IL 60126-2400
(847) 774-1500
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-004129
IL
Other
Enumeration date
09/13/2011
Last updated
09/23/2011
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