Provider Demographics
NPI:1659639862
Name:KLEIN, COLLETTE ANN (RN MSN FPMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:COLLETTE
Middle Name:ANN
Last Name:KLEIN
Suffix:
Gender:F
Credentials:RN MSN FPMHNP-BC
Other - Prefix:MRS
Other - First Name:COLLETTE
Other - Middle Name:ANN
Other - Last Name:ANSTETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, CNP-PMHNP
Mailing Address - Street 1:12 HEALTH SERVICES DR
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-9637
Mailing Address - Country:US
Mailing Address - Phone:815-756-4875
Mailing Address - Fax:
Practice Address - Street 1:12 HEALTH SERVICES DR
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9637
Practice Address - Country:US
Practice Address - Phone:815-756-4875
Practice Address - Fax:815-746-2944
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.009393363LP0808X
ILMK2598069363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health