Individual
KELLY CANERDAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
40 75TH ST STE 1630, WILLOWBROOK, IL 60527-2325
(630) 581-5372
Mailing address
40 75TH ST STE 1630, WILLOWBROOK, IL 60527-2325
(630) 581-5372
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209010147
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F400219797
MEDICARE PTAN
IL
Enumeration date
04/09/2013
Last updated
06/28/2021
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