Provider Demographics
NPI:1346545993
Name:KEMP, NANCY A (DN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:KEMP
Suffix:
Gender:F
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:POWERS LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53159-0457
Mailing Address - Country:US
Mailing Address - Phone:847-299-4295
Mailing Address - Fax:
Practice Address - Street 1:800 MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-1542
Practice Address - Country:US
Practice Address - Phone:847-299-4295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181000172208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL181000172OtherPROFESSIONAL LICENSE