Healthcare Provider Details

I. General information

NPI: 1497107296
Provider Name (Legal Business Name): KATHRYN A SWAIN-ABRAHAM APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN A SWAIN APN

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W MARKET ST
BLOOMINGTON IL
61701-3918
US

IV. Provider business mailing address

108 W MARKET ST
BLOOMINGTON IL
61701-3918
US

V. Phone/Fax

Practice location:
  • Phone: 309-827-5351
  • Fax:
Mailing address:
  • Phone: 309-827-5351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277001390
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71011103A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209-014407
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: