Healthcare Provider Details

I. General information

NPI: 1265898928
Provider Name (Legal Business Name): KATHERINE PIEKARZ APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 DUNDEE AVE
ELGIN IL
60120-4205
US

IV. Provider business mailing address

450 DUNDEE AVE
ELGIN IL
60120-4205
US

V. Phone/Fax

Practice location:
  • Phone: 844-599-3700
  • Fax: 847-608-4767
Mailing address:
  • Phone: 844-599-3700
  • Fax: 847-608-4767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209.013709
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.413438
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: