Provider Demographics
NPI:1578574802
Name:CAVITT, KATHRYN D I (CFNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:D
Last Name:CAVITT
Suffix:I
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MANTENO
Mailing Address - State:IL
Mailing Address - Zip Code:60950
Mailing Address - Country:US
Mailing Address - Phone:815-468-8341
Mailing Address - Fax:
Practice Address - Street 1:606 POTTER RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-5337
Practice Address - Country:US
Practice Address - Phone:800-570-8809
Practice Address - Fax:847-759-9448
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL41-155407163W00000X
IL363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0091641236OtherBCBS
ILP00224987OtherRR MEDICARE
ILK18271Medicare ID - Type Unspecified
ILK18272Medicare ID - Type Unspecified
ILP00224987OtherRR MEDICARE
IL0091641236OtherBCBS