Provider Demographics
NPI:1194197186
Name:ENGELKE, KATHERINE J (APN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:J
Last Name:ENGELKE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:J
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:10 SAINT CLARE CT
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-9239
Mailing Address - Country:US
Mailing Address - Phone:309-886-4000
Mailing Address - Fax:309-886-4118
Practice Address - Street 1:10 SAINT CLARE CT
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-9239
Practice Address - Country:US
Practice Address - Phone:309-886-4000
Practice Address - Fax:309-886-4118
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-013495363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner