Healthcare Provider Details

I. General information

NPI: 1174732150
Provider Name (Legal Business Name): KATE A ABITOGUN RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 WILLOW SPRINGS RD
SPRINGFIELD IL
62712-9590
US

IV. Provider business mailing address

6201 WILLOW SPRINGS RD
SPRINGFIELD IL
62712-9590
US

V. Phone/Fax

Practice location:
  • Phone: 217-553-7874
  • Fax:
Mailing address:
  • Phone: 217-553-7874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: