Provider Demographics
NPI:1114229713
Name:KLERONOMOS, ROBIN S (APN)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:S
Last Name:KLERONOMOS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1222
Mailing Address - Country:US
Mailing Address - Phone:630-933-4847
Mailing Address - Fax:630-933-3826
Practice Address - Street 1:25 N WINFIELD RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1222
Practice Address - Country:US
Practice Address - Phone:630-933-4847
Practice Address - Fax:630-933-3826
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.008458363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01013419OtherMEDICARE RAILROAD (INDIVIDUAL)
206147064OtherMEDICARE PTAN (INDIVIDUAL)
ILCA4748OtherMEDICARE RAILROAD (GROUP)
206147OtherMEDICARE PTAN (GROUP)
206147064OtherMEDICARE PTAN (INDIVIDUAL)