Forner, Judi Kittle

Forner, Judi Kittle is an individual health care provider with primary practice located at 4309 W Medical Center Dr Ste A200 , Mchenry IL 60050. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Adult Health, which is considered as her primary health care specialty. Forner, Judi Kittle can be contacted via phone (815) 759-8070.

Contact Information

Primary practice address
4309 W Medical Center Dr Ste A200 Mchenry IL 60050
Fax: (815) 759-4931
Website:

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 364SA2200X 209010514 Illinois

Profile Details

NPI number 1194123679
LBN Legal business name Forner, Judi Kittle
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 15th, 2014
Last updated Oct 19th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194123679 NPPES
Illinois Other 209010514 STATE LICENSE

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