Healthcare Provider Details

I. General information

NPI: 1386830495
Provider Name (Legal Business Name): KATHERINE A WITTLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

7642 W 158TH CT
ORLAND PARK IL
60462-5068
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-1646
  • Fax: 708-684-4068
Mailing address:
  • Phone: 708-684-3029
  • Fax: 708-684-4068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number209.006655
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: