Healthcare Provider Details

I. General information

NPI: 1548700396
Provider Name (Legal Business Name): KATIE SLOMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE PINSKER FNP

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E PLUMMER BLVD
CHATHAM IL
62629-8047
US

IV. Provider business mailing address

101 E PLUMMER BLVD
CHATHAM IL
62629-8047
US

V. Phone/Fax

Practice location:
  • Phone: 217-483-3487
  • Fax: 217-483-8150
Mailing address:
  • Phone: 217-483-3487
  • Fax: 217-483-8150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209015679
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: