Provider Demographics
NPI:1447821558
Name:KEDZIE, NICOLE (CPM)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:KEDZIE
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 QUAIL HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:STEWARD
Mailing Address - State:IL
Mailing Address - Zip Code:60553-9775
Mailing Address - Country:US
Mailing Address - Phone:630-802-1869
Mailing Address - Fax:
Practice Address - Street 1:1818 QUAIL HOLLOW RD
Practice Address - Street 2:
Practice Address - City:STEWARD
Practice Address - State:IL
Practice Address - Zip Code:60553-9775
Practice Address - Country:US
Practice Address - Phone:630-802-1869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife