Provider Demographics
NPI:1457906570
Name:CAVERO, NELLY S
Entity Type:Individual
Prefix:MRS
First Name:NELLY
Middle Name:S
Last Name:CAVERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 N 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-4011
Mailing Address - Country:US
Mailing Address - Phone:773-706-6663
Mailing Address - Fax:
Practice Address - Street 1:1 EXECUTIVE CT STE 1
Practice Address - Street 2:
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9533
Practice Address - Country:US
Practice Address - Phone:847-882-2030
Practice Address - Fax:847-294-1954
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.019741363L00000X
IL209019741363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner