MEDICARE: AGNES F KASPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	209.019655	IL
2	363LA2200X	Adult Health Nurse Practitioner	209019655	IL

General Provider Information

NPI Number	:	1841847266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGNES F KASPA

Provider Business Mailing Address
First Line	:	102 E CHESTNUT DR
Second Line	:
City	:	STREAMWOOD
State	:	IL
Zip	:	60107-1442
Country	:	US
Telephone Number	:	847-962-9588
Fax Number	:

Provider Business Practice Location Address
First Line	:	7444 W WILSON AVE
Second Line	:
City	:	HARWOOD HEIGHTS
State	:	IL
Zip	:	60706-4500
Country	:	US
Telephone Number	:	747-885-1818
Fax Number	:	708-695-5030

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2019
Last Update Date	:	04/24/2026

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Directions to “ AGNES F KASPA ” Practice Location

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