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General NPI Number Information
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NPI Number | 1659373132
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Entity Type | Organization
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Legal Business Name | K C A S ENT INC.
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Dates
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Enumeration Date | 08/13/2005
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Last Update Date | 11/24/2010
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Provider Practice Location Address
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Address Line | 706 N TAYLOR ST
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City | MARENGO
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State | IL
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Zip | 60152-2457
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Country | US
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Telephone | 815-568-0243
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Fax | 815-568-5350
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Provider Business Mailing Address
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Address Line | 706 N TAYLOR ST
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City | MARENGO
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State | IL
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Zip | 60152-2457
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Country | US
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Telephone | 815-568-0243
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Fax | 815-568-5350
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Authorized Official
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Title or Position | ADVANCED PRACTICE NURSE PRACTITIONE
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Name | MRS. KATHLEEN L LUDWIKOWSKI
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Credential | APN
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Telephone | 815-568-0243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 209000890
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License Number State | IL
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