Provider Demographics
NPI:1114316189
Name:KLOPACK, ERIN A (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:A
Last Name:KLOPACK
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:870 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1521
Mailing Address - Country:US
Mailing Address - Phone:847-475-2273
Mailing Address - Fax:847-535-7761
Practice Address - Street 1:870 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1521
Practice Address - Country:US
Practice Address - Phone:847-475-2273
Practice Address - Fax:847-535-7761
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011576363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041347457OtherRN LICENSE
IL209011576OtherLICENSE