Provider Demographics
NPI:1558005728
Name:SWANSON, KATIE (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:630-556-7808
Mailing Address - Fax:847-390-4757
Practice Address - Street 1:13900 QUALITY DR
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-8098
Practice Address - Country:US
Practice Address - Phone:847-967-7800
Practice Address - Fax:847-961-7801
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209025091363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily