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General NPI Number Information
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NPI Number | 1053790345
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Entity Type | Individual
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Provider Name | CATHERINE LYNN STULL FNP BC
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Gender | Female
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 4001 W DEVON AVE STE 206
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City | CHICAGO
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State | IL
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Zip | 60646-4537
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Country | US
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Telephone | 847-722-4901
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Fax |
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Provider Business Mailing Address
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Address Line | 5341 CAROL ST
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City | SKOKIE
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State | IL
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Zip | 60077-2002
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Country | US
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Telephone | 847-722-4901
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Fax | 847-965-1952
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.011876
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 277001363
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License Number State | IL
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