Healthcare Provider Details

I. General information

NPI: 1861321507
Provider Name (Legal Business Name): KATRINA LEWIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S DAMEN AVE
CHICAGO IL
60612-3728
US

IV. Provider business mailing address

1821 S SPAULDING AVE
CHICAGO IL
60623-2649
US

V. Phone/Fax

Practice location:
  • Phone: 312-569-8387
  • Fax: 312-569-8788
Mailing address:
  • Phone: 773-829-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number041.496142
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: