Healthcare Provider Details

I. General information

NPI: 1851775977
Provider Name (Legal Business Name): EMILY KATE BERWALD APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2015
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 W WILSON AVE
CHICAGO IL
60640-8090
US

IV. Provider business mailing address

1476 W FOSTER AVE APT 3W
CHICAGO IL
60640-0763
US

V. Phone/Fax

Practice location:
  • Phone: 773-506-4283
  • Fax: 773-275-3689
Mailing address:
  • Phone: 616-502-1255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209012222
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209012222
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number209012222
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: