Individual
MARY KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
105 E HACK ST, CULLOM, IL 60929
(815) 689-2126
(815) 689-2131
Mailing address
105 E HACK ST, CULLOM, IL 60929
(815) 689-2126
(815) 689-2131
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
041127471/209001007
IL
Other
Enumeration date
10/02/2006
Last updated
07/08/2007
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