Provider Demographics
NPI:1356614796
Name:NICHOLS, KRISTINE (APN, FNP-C)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:APN, FNP-C
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:LYNETTE
Other - Last Name:MONTERO NICHOLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1127 S YORK RD
Mailing Address - Street 2:ELMHURT-EDWARD WALK IN CLINIC IN JEWEL
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-3342
Mailing Address - Country:US
Mailing Address - Phone:331-221-2830
Mailing Address - Fax:
Practice Address - Street 1:1127 S YORK RD
Practice Address - Street 2:ELMHURT-EDWARD WALK IN CLINIC IN JEWEL
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-3342
Practice Address - Country:US
Practice Address - Phone:331-221-2830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009118363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily