Provider Demographics
NPI:1881347946
Name:GARCIA, KELLY SUZANNE (BSN, RN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:SUZANNE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:BSN, RN, FNP-BC
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:SUZANNE
Other - Last Name:O'DONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:851 PAPOOSE CT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-1431
Mailing Address - Country:US
Mailing Address - Phone:708-769-1710
Mailing Address - Fax:
Practice Address - Street 1:600 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1922
Practice Address - Country:US
Practice Address - Phone:312-728-4728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-30
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.024727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily