MEDICARE: CATHERINE LYNN STULL FNP BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209.011876	IL
2	363L00000X	Nurse Practitioner	277001363	IL

General Provider Information

NPI Number	:	1053790345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE LYNN STULL FNP BC

Provider Business Mailing Address
First Line	:	5341 CAROL ST
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-2002
Country	:	US
Telephone Number	:	847-722-4901
Fax Number	:	847-965-1952

Provider Business Practice Location Address
First Line	:	4001 W DEVON AVE STE 206
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-4537
Country	:	US
Telephone Number	:	847-722-4901
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2015
Last Update Date	:	12/13/2024

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