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General NPI Number Information
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NPI Number | 1346128915
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Entity Type | Individual
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Provider Name | KATRINA WIEDENFELD APRN, CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 08/22/2025
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 70 MEADOWVIEW CTR STE 300
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City | KANKAKEE
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State | IL
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Zip | 60901-2062
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Country | US
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Telephone | 815-802-0022
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Fax | 815-802-0011
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Provider Business Mailing Address
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Address Line | 1108 KENSINGTON ST
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City | SHOREWOOD
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State | IL
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Zip | 60404-9407
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Country | US
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Telephone | 815-546-6186
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 209.033009
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License Number State | IL
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