Provider Demographics
NPI:1235809773
Name:GUATELARA, KATHERINA (APRN)
Entity Type:Individual
Prefix:
First Name:KATHERINA
Middle Name:
Last Name:GUATELARA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25100 DECLARATION DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2736
Mailing Address - Country:US
Mailing Address - Phone:312-404-5915
Mailing Address - Fax:
Practice Address - Street 1:2000 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-5893
Practice Address - Country:US
Practice Address - Phone:630-978-6870
Practice Address - Fax:630-978-6780
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily