Provider Demographics
NPI:1053530998
Name:FERNANDEZ, KELSEY JANE (L AC- NMD)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:JANE
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:L AC- NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7627 LAKE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1878
Mailing Address - Country:US
Mailing Address - Phone:708-769-9929
Mailing Address - Fax:708-395-2641
Practice Address - Street 1:7627 LAKE ST STE 201
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1878
Practice Address - Country:US
Practice Address - Phone:708-689-0473
Practice Address - Fax:708-395-2641
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198-000448171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist