Healthcare Provider Details

I. General information

NPI: 1043648744
Provider Name (Legal Business Name): KATHRYN R PENNELL APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN R ROGGE APRN, CNP

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 09/29/2026
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10350 HALIGUS RD STE 200D
HUNTLEY IL
60142-9545
US

IV. Provider business mailing address

10400 HALIGUS RD
HUNTLEY IL
60142-9553
US

V. Phone/Fax

Practice location:
  • Phone: 847-802-7280
  • Fax: 847-802-7275
Mailing address:
  • Phone: 224-654-0040
  • Fax: 224-654-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209010782
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.010782
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: