Provider Demographics
NPI:1689345084
Name:IMUNDO, KIMBERLY CAROL (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CAROL
Last Name:IMUNDO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2956 SAVANNAH DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-8678
Mailing Address - Country:US
Mailing Address - Phone:708-267-7172
Mailing Address - Fax:
Practice Address - Street 1:503 S ILLINOIS ROUTE 59
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-8168
Practice Address - Country:US
Practice Address - Phone:331-200-5525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277.003266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily