Healthcare Provider Details

I. General information

NPI: 1962283697
Provider Name (Legal Business Name): KATLYNN KLINETOBE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 75TH ST
WILLOWBROOK IL
60527-2325
US

IV. Provider business mailing address

40 75TH ST
WILLOWBROOK IL
60527-2325
US

V. Phone/Fax

Practice location:
  • Phone: 630-581-5372
  • Fax:
Mailing address:
  • Phone: 630-581-5372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.027765
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: