Alicia Kay Vander Wal, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

041478493 Issued in IL

Practice address

1015 W Lawrence Ave FL 2
Chicago, IL 60640-5017

Phone

(773) 751-1731

Fax

(773) 275-3695

NPI assigned

Mar 29, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556064000000",
    "number": "1891256020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4368 72ND AVE",
            "city": "ZEELAND",
            "state": "MI",
            "postal_code": "494649459",
            "telephone_number": "616-848-0402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 W LAWRENCE AVE FL 2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405017",
            "telephone_number": "773-751-1731",
            "fax_number": "773-275-3695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDER WAL",
        "first_name": "ALICIA",
        "middle_name": "KAY",
        "name_prefix": "Ms.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-29",
        "last_updated": "2019-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704315107",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041478493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly A Vander Griend, LCSW
• Marisa Vander Meeden, PA
• Karin E Vander Ploeg Booth
• Daphne L Vander Roest, M.D.
• Patricia A. Vander Sande, LCPC
• Allison Vander Wall
• Susan Vanderberg-Dent, MD
• Vanderbilt Home Care Corp
• Madeline Vanderheid-Nye
• Elizabeth Vanderlaan, LCSW

• Registered Nurse in Chicago, IL
• Providers in Chicago, IL by specialty
• Registered Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 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.

Verify at the official NPI Registry.