Provider Demographics
NPI:1154427193
Name:KADOLPH, NORA GUMAYAGAY (APN)
Entity type:Individual
Prefix:MRS
First Name:NORA
Middle Name:GUMAYAGAY
Last Name:KADOLPH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 FLETCHER DR
Mailing Address - Street 2:STE 305
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4756
Mailing Address - Country:US
Mailing Address - Phone:847-742-3333
Mailing Address - Fax:847-742-9070
Practice Address - Street 1:750 FLETCHER DR STE 305
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4756
Practice Address - Country:US
Practice Address - Phone:847-742-3333
Practice Address - Fax:847-742-3070
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-004307363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205749Medicare ID - Type Unspecified