Individual
MRS. NICOLA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
1000 BURR RIDGE PKWY STE 201, BURR RIDGE, IL 60527-0864
(312) 818-4650
(855) 618-2629
Mailing address
PO BOX 639295 DEPT 93394, CINCINNATI, OH 45263-9295
(484) 346-1692
(855) 618-6655
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209.014255
IL
363L00000X
Nurse Practitioner
Primary
6958-33
WI
363LA2200X
Adult Health Nurse Practitioner
209.014255
IL
363LG0600X
Gerontology Nurse Practitioner
209.014255
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942655865
—
WI
Enumeration date
04/28/2016
Last updated
11/15/2022
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