Provider Demographics
NPI:1922438332
Name:BEVERLY KNIGGE MEDICAL SC
Entity Type:Organization
Organization Name:BEVERLY KNIGGE MEDICAL SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:KNIGGE
Authorized Official - Suffix:
Authorized Official - Credentials:APN, CNP
Authorized Official - Phone:630-248-1236
Mailing Address - Street 1:2425 W 22ND STREET
Mailing Address - Street 2:SUITE 211
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1247
Mailing Address - Country:US
Mailing Address - Phone:630-568-3912
Mailing Address - Fax:630-581-5286
Practice Address - Street 1:2425 W 22ND STREET
Practice Address - Street 2:SUITE 211
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1247
Practice Address - Country:US
Practice Address - Phone:630-568-3912
Practice Address - Fax:630-581-5286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-21
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002192363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty