Provider Demographics
NPI:1083682652
Name:POWELL, KATHRYN WIRTZ (NP)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:WIRTZ
Last Name:POWELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 N RACINE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-4127
Mailing Address - Country:US
Mailing Address - Phone:312-469-4513
Mailing Address - Fax:312-469-4507
Practice Address - Street 1:333 E HURON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3004
Practice Address - Country:US
Practice Address - Phone:312-469-4513
Practice Address - Fax:312-469-4507
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily