Provider Demographics
NPI:1407906126
Name:ADAMSON, CATHY JO (NP)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:JO
Last Name:ADAMSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:JO
Other - Last Name:IRELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:133 E BRUSH HILL RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5661
Mailing Address - Country:US
Mailing Address - Phone:331-231-6200
Mailing Address - Fax:331-231-6201
Practice Address - Street 1:133 E BRUSH HILL RD STE 202
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5661
Practice Address - Country:US
Practice Address - Phone:331-231-6200
Practice Address - Fax:331-231-6201
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001646363LA2200X
IL277.000637363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400229434OtherMEDICARE - LOCALITY 16
IL1912218850OtherNPI GROUP PRACTICE
ILF400229436OtherMEDICARE - LOCALITY 15