Individual
KELLY KATHLEEN FORSTER IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM, WHNP-BC
Contact information
Practice address
900 N WESTMORELAND RD STE 112, LAKE FOREST, IL 60045
(847) 535-7057
(847) 615-2260
Mailing address
900 N WESTMORELAND RD STE 112, LAKE FOREST, IL 60045
(847) 535-7057
(847) 615-2260
Taxonomy
Speciality
Code
Description
License number
State
163WX0003X
Inpatient Obstetric Registered Nurse
041369474
IL
363L00000X
Nurse Practitioner
Primary
277001068
IL
367A00000X
Advanced Practice Midwife
209009824
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209010141
STATE LICENSE
IL
Enumeration date
11/19/2012
Last updated
08/05/2024
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