Provider Demographics
NPI:1639597560
Name:SAS, KATHRYN E (APN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:SAS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:E
Other - Last Name:MICHNIOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4201 WINFIELD RD
Mailing Address - Street 2:CENTRALIZED SERVICES
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-4025
Mailing Address - Country:US
Mailing Address - Phone:331-221-6377
Mailing Address - Fax:
Practice Address - Street 1:130 S MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2670
Practice Address - Country:US
Practice Address - Phone:331-221-9001
Practice Address - Fax:331-221-3957
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041398502163W00000X
IL209013685363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILPENDINGMedicaid
ILPENDINGMedicare Oscar/Certification