Provider Demographics
NPI:1518103134
Name:MUDDAMALLE, HELEN MARY (NP)
Entity Type:Individual
Prefix:MRS
First Name:HELEN
Middle Name:MARY
Last Name:MUDDAMALLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 MARNE RD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-4597
Mailing Address - Country:US
Mailing Address - Phone:630-226-1584
Mailing Address - Fax:
Practice Address - Street 1:1900 MARNE RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-4597
Practice Address - Country:US
Practice Address - Phone:630-226-1584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007383363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily