Provider Demographics
NPI:1659820280
Name:GEBHARDT, KATIE LYNN (CPNP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:GEBHARDT
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W MADISON ST UNIT 502
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3371
Mailing Address - Country:US
Mailing Address - Phone:630-272-0426
Mailing Address - Fax:
Practice Address - Street 1:121 S WILKE RD STE 605
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1529
Practice Address - Country:US
Practice Address - Phone:847-259-8379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.414190163W00000X
IL209.014848363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse