Provider Demographics
NPI:1194015172
Name:LAWLOR, KYLENE (NP)
Entity Type:Individual
Prefix:
First Name:KYLENE
Middle Name:
Last Name:LAWLOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:205 E BUTTERFIELD RD # 297
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5103
Mailing Address - Country:US
Mailing Address - Phone:708-795-0100
Mailing Address - Fax:708-795-0101
Practice Address - Street 1:205 E BUTTERFIELD RD # 297
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5103
Practice Address - Country:US
Practice Address - Phone:708-795-0100
Practice Address - Fax:708-795-0101
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.008763363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209-008763Medicaid