Provider Demographics
NPI:1225697634
Name:VENEZIA, KATHERYN (APN)
Entity Type:Individual
Prefix:
First Name:KATHERYN
Middle Name:
Last Name:VENEZIA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9139 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1303
Mailing Address - Country:US
Mailing Address - Phone:708-387-9982
Mailing Address - Fax:
Practice Address - Street 1:1299 E OGDEN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1603
Practice Address - Country:US
Practice Address - Phone:866-389-3272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018149363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209018149OtherADVANCED PRACTICE NURSE PRACTITIONER