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General NPI Number Information
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NPI Number | 1548644545
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Entity Type | Individual
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Provider Name | KATELYN MARIE VANDERMAST APN, FNP-BC, NP-C
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Gender | Female
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Dates
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Enumeration Date | 07/20/2015
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Last Update Date | 07/28/2023
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Provider Practice Location Address
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Address Line | 1850 GATEWAY DR STE 201
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City | SYCAMORE
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State | IL
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Zip | 60178-3192
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Country | US
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Telephone | 815-766-7021
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Fax | 815-758-5690
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Provider Business Mailing Address
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Address Line | 1850 GATEWAY DR STE 201
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City | SYCAMORE
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State | IL
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Zip | 60178-3192
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Country | US
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Telephone | 815-766-7021
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Fax | 815-758-5690
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041-390433
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 209013007
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | 209013007
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209013007
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License Number State | IL
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