MEDICARE: MRS. KATHERINE GRACE KROB APN, WHNP

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	363LW0102X	Women's Health Nurse Practitioner	209019290	IL

General Provider Information

NPI Number	:	1508428939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHERINE GRACE KROB APN, WHNP

Provider Business Mailing Address
First Line	:	PO BOX 14000
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4033
Country	:	US
Telephone Number	:	773-435-9036
Fax Number	:

Provider Business Practice Location Address
First Line	:	1455 N MILWAUKEE AVE FL 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2015
Country	:	US
Telephone Number	:	773-435-9036
Fax Number	:

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

Provider Enumeration Date	:	07/05/2019
Last Update Date	:	01/18/2021

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