Healthcare Provider Details

I. General information

NPI: 1912707746
Provider Name (Legal Business Name): KAITLYN ANWAR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 95TH ST STE 105
NAPERVILLE IL
60564-7802
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 630-646-6920
  • Fax: 630-646-6925
Mailing address:
  • Phone: 847-570-2040
  • Fax: 847-733-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.031779
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: