Active NPI
Kelley Louise Enzweiler, DNP
- Nurse Practitioner
- Evanston, IL
National Provider Identifier
1669029013
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 209019667
- Practice address
- 2650 Ridge Ave
Evanston, IL 60201-1700 - Phone
- (847) 570-2040
- NPI assigned
- Aug 21, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 209019667 | IL | Primary |
Addresses
Primary practice location
2650 Ridge Ave
Evanston, IL 60201-1700
Mailing address
9977 Woods Dr
Skokie, IL 60077-1057
Phone (847) 663-2655
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209019667 | IL | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570752000000",
"number": "1669029013",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9977 WOODS DR",
"city": "SKOKIE",
"state": "IL",
"postal_code": "600771057",
"telephone_number": "847-663-2655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2650 RIDGE AVE",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602011700",
"telephone_number": "847-570-2040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENZWEILER",
"first_name": "KELLEY",
"middle_name": "LOUISE",
"credential": "DNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-21",
"last_updated": "2019-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IL",
"license": "209019667",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evanston, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.