Provider Demographics
NPI:1043728322
Name:GENELLY, NICOLA ANN (MSN, RNC, IBCLC, CCE)
Entity Type:Individual
Prefix:MRS
First Name:NICOLA
Middle Name:ANN
Last Name:GENELLY
Suffix:
Gender:F
Credentials:MSN, RNC, IBCLC, CCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 W HUTCHINSON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-1989
Mailing Address - Country:US
Mailing Address - Phone:773-551-3106
Mailing Address - Fax:
Practice Address - Street 1:4545 W HUTCHINSON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-1989
Practice Address - Country:US
Practice Address - Phone:773-551-3106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.264802163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant