Provider Demographics
NPI:1578921599
Name:KOTZ, KAREN J (PHD, NNP-BC, APNP)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:J
Last Name:KOTZ
Suffix:
Gender:F
Credentials:PHD, NNP-BC, APNP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:JANE
Other - Last Name:FISHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NNP-BC, APN
Mailing Address - Street 1:1775 DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1143
Mailing Address - Country:US
Mailing Address - Phone:847-723-5313
Mailing Address - Fax:847-723-2338
Practice Address - Street 1:1775 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1143
Practice Address - Country:US
Practice Address - Phone:847-723-5313
Practice Address - Fax:847-723-2338
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6804363L00000X
IL209-004682363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100092932Medicaid