Healthcare Provider Details

I. General information

NPI: 1619219110
Provider Name (Legal Business Name): KATHLEEN ANN ULIVI FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 N US ROUTE 53
GARDNER IL
60424
US

IV. Provider business mailing address

1570 PERIWINKLE DR
MORRIS IL
60450-6840
US

V. Phone/Fax

Practice location:
  • Phone: 815-237-0413
  • Fax: 815-237-0514
Mailing address:
  • Phone: 815-405-7195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.010293
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: