Healthcare Provider Details

I. General information

NPI: 1144913724
Provider Name (Legal Business Name): KATIE ONSRUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 E STATE ST STE 1
ROCKFORD IL
61108-2521
US

IV. Provider business mailing address

333 N SUMMIT ST
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 800-427-1902
  • Fax:
Mailing address:
  • Phone:
  • Fax: 800-564-5952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022003202
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: