Healthcare Provider Details

I. General information

NPI: 1063395341
Provider Name (Legal Business Name): KAITLYN NAFZIGER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HEARTLAND DR STE C
BLOOMINGTON IL
61704-7733
US

IV. Provider business mailing address

9 HEARTLAND DR STE C
BLOOMINGTON IL
61704-7733
US

V. Phone/Fax

Practice location:
  • Phone: 309-663-7642
  • Fax:
Mailing address:
  • Phone: 309-663-7642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209.032822
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: