Provider Demographics
NPI:1831562859
Name:RICCI, KIMBERLY S (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:RICCI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E BRUSH HILL RD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5658
Mailing Address - Country:US
Mailing Address - Phone:331-221-0323
Mailing Address - Fax:331-221-3718
Practice Address - Street 1:155 E BRUSH HILL RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5658
Practice Address - Country:US
Practice Address - Phone:331-221-0323
Practice Address - Fax:331-221-3718
Is Sole Proprietor?:No
Enumeration Date:2015-11-13
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013482363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner