Healthcare Provider Details

I. General information

NPI: 1053397687
Provider Name (Legal Business Name): KATHRYN A. GIETL R.N.C.,W.H.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W CARPENTER ST
SPRINGFIELD IL
62702-4902
US

IV. Provider business mailing address

350 W CARPENTER ST
SPRINGFIELD IL
62702-4902
US

V. Phone/Fax

Practice location:
  • Phone: 217-525-0210
  • Fax: 217-525-1007
Mailing address:
  • Phone: 217-525-0210
  • Fax: 217-525-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: