Healthcare Provider Details

I. General information

NPI: 1871227462
Provider Name (Legal Business Name): KATHERINE LYNN WILHELM DNP, AG-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/11/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 BEVERLY BLVD FL 3
WEST HOLLYWOOD CA
90048-2438
US

IV. Provider business mailing address

401 SHIRLEY PL APT 206
BEVERLY HILLS CA
90212-4135
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-2641
  • Fax:
Mailing address:
  • Phone: 309-846-4728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95019012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: