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Individual

KELLY M BROEDERDORF

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
REGISTERED NURSE

Contact information

Practice address
3707 DOTY RD STE CANDD, WOODSTOCK, IL 60098-7530
(815) 338-6600
(815) 206-1086
Mailing address
3707 DOTY RD STE CANDD, WOODSTOCK, IL 60098-7530
(815) 338-6600
(815) 206-1086

Taxonomy

Speciality
Code
Description
License number
State
163WX0200X
Oncology Registered Nurse
041.387373
IL
363L00000X
Nurse Practitioner
Primary
209027210
IL
363LF0000X
Family Nurse Practitioner
209-027210
IL

Other

Enumeration date
09/13/2022
Last updated
06/10/2024
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