Healthcare Provider Details

I. General information

NPI: 1164804316
Provider Name (Legal Business Name): KATHERINE SPALDING APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2088 OGDEN AVE SUITE 160
AURORA IL
60504-4376
US

IV. Provider business mailing address

2088 OGDEN AVE STE 160
AURORA IL
60504-4383
US

V. Phone/Fax

Practice location:
  • Phone: 630-851-6440
  • Fax:
Mailing address:
  • Phone: 630-851-6440
  • Fax: 630-851-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209.012815
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: