Healthcare Provider Details

I. General information

NPI: 1659639862
Provider Name (Legal Business Name): COLLETTE ANN KLEIN RN MSN FPMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLETTE ANN ANSTETH APRN, CNP-PMHNP

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 GATEWAY DR STE 202
SYCAMORE IL
60178-3192
US

IV. Provider business mailing address

1850 GATEWAY DR STE 202
SYCAMORE IL
60178-3192
US

V. Phone/Fax

Practice location:
  • Phone: 815-766-9841
  • Fax: 815-758-5491
Mailing address:
  • Phone: 815-766-9841
  • Fax: 815-758-5491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277001043
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277.001043
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: