Provider Demographics
NPI:1639417736
Name:BETTINARDI ANGRES, KATHY B (APN)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:B
Last Name:BETTINARDI ANGRES
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
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Mailing Address - Street 1:505 N MCCLURG CT
Mailing Address - Street 2:APT. #2203
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5420
Mailing Address - Country:US
Mailing Address - Phone:847-493-3528
Mailing Address - Fax:847-493-3531
Practice Address - Street 1:2913 N COMMONWEALTH AVE
Practice Address - Street 2:MANOR BUILDING 6TH FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6211
Practice Address - Country:US
Practice Address - Phone:847-493-3528
Practice Address - Fax:847-493-3531
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL309.002829363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health