Healthcare Provider Details

I. General information

NPI: 1245915495
Provider Name (Legal Business Name): KRISTEN TERESE REPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2033 W ROSCOE ST
CHICAGO IL
60618-6386
US

IV. Provider business mailing address

2033 W ROSCOE ST
CHICAGO IL
60618-6386
US

V. Phone/Fax

Practice location:
  • Phone: 312-479-7853
  • Fax:
Mailing address:
  • Phone: 312-479-7853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277.004537
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: