Provider Demographics
NPI:1891127395
Name:MADER, KRISTEN LEE (RN, BSN, MSN, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:LEE
Last Name:MADER
Suffix:
Gender:F
Credentials:RN, BSN, MSN, FNP-BC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:NICHOLLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 N WINFIELD RD STE 432
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1379
Mailing Address - Country:US
Mailing Address - Phone:630-933-4056
Mailing Address - Fax:630-933-5868
Practice Address - Street 1:25 N WINFIELD RD STE 432
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1379
Practice Address - Country:US
Practice Address - Phone:630-933-4056
Practice Address - Fax:630-933-5868
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily