Provider Demographics
NPI:1275151250
Name:RACINE, KATHERINE FRANCES SABELLA (APN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:FRANCES SABELLA
Last Name:RACINE
Suffix:
Gender:F
Credentials:APN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W CALENDAR AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2325
Mailing Address - Country:US
Mailing Address - Phone:708-745-5277
Mailing Address - Fax:
Practice Address - Street 1:110 W CALENDAR AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2325
Practice Address - Country:US
Practice Address - Phone:708-745-5277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.023739363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health