Provider Demographics
NPI:1639521669
Name:KALVODA, NATALIE JOANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:JOANN
Last Name:KALVODA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:NATALIE
Other - Middle Name:JOANN
Other - Last Name:WOLFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:420 S. SCHMIDT ROAD
Mailing Address - Street 2:#240
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1452
Mailing Address - Country:US
Mailing Address - Phone:630-312-4505
Mailing Address - Fax:
Practice Address - Street 1:420 REMINGTON BLVD STE 125
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-4950
Practice Address - Country:US
Practice Address - Phone:630-312-4505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.014379363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily