MEDICARE: KATHRINE SUNSTEDT CPNP-AC

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	363LP0222X	Critical Care Pediatric Nurse Practitioner	209.021251	IL

General Provider Information

NPI Number	:	1942801071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRINE SUNSTEDT CPNP-AC

Provider Business Mailing Address
First Line	:	1800 N KNOXVILLE AVE STE C
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61603-3005
Country	:	US
Telephone Number	:	309-989-0046
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 N KNOXVILLE AVE STE C
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61603-3005
Country	:	US
Telephone Number	:	309-624-9680
Fax Number	:	309-624-9524

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

Provider Enumeration Date	:	11/04/2020
Last Update Date	:	05/11/2026

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Directions to “ KATHRINE SUNSTEDT CPNP-AC” Practice Location

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