Healthcare Provider Details

I. General information

NPI: 1447403571
Provider Name (Legal Business Name): AASTA KNOX APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18416 WILLOW LN
LANSING IL
60438-3372
US

IV. Provider business mailing address

18416 WILLOW LN
LANSING IL
60438-3372
US

V. Phone/Fax

Practice location:
  • Phone: 708-704-8306
  • Fax:
Mailing address:
  • Phone: 708-704-8306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209026865
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number209005641
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2278P1005X
TaxonomyPulmonary Rehabilitation Certified Respiratory Therapist
License Number209.005641
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: