Healthcare Provider Details

I. General information

NPI: 1801723804
Provider Name (Legal Business Name): DENISE CATHERINE SAMPLE MSN, APN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 W MEDICAL CENTER DR STE 1
MCHENRY IL
60050-8425
US

IV. Provider business mailing address

4305 W MEDICAL CENTER DR STE 1
MCHENRY IL
60050-8425
US

V. Phone/Fax

Practice location:
  • Phone: 847-535-7058
  • Fax: 847-535-7023
Mailing address:
  • Phone: 847-535-7058
  • Fax: 847-535-7023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.276148
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.035555
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: