Provider Demographics
NPI:1477818557
Name:OMEROD, KATHLEEN (APN CCNS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:OMEROD
Suffix:
Gender:F
Credentials:APN CCNS
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:FARLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1860 PAYSPHERE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 SPALDING DR STE 205
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6527
Practice Address - Country:US
Practice Address - Phone:630-646-6022
Practice Address - Fax:630-527-6400
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001704364S00000X, 364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology