Provider Demographics
NPI:1376316968
Name:WESTERBERG, KATRINA MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:MARIE
Last Name:WESTERBERG
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 1:522 CALDUTO CIR
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3484
Mailing Address - Country:US
Mailing Address - Phone:309-824-4611
Mailing Address - Fax:
Practice Address - Street 1:1851 SILVER CROSS BLVD STE 150
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9629
Practice Address - Country:US
Practice Address - Phone:815-215-8292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.028585363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care