Provider Demographics
NPI:1861678294
Name:VANDERZWAN, KATHRYN JULIA (MS, APN/CNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:JULIA
Last Name:VANDERZWAN
Suffix:
Gender:F
Credentials:MS, APN/CNP
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:JULIA
Other - Last Name:SZIGETVARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, APN/CNP
Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-1463
Mailing Address - Fax:847-733-5108
Practice Address - Street 1:2650 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1718
Practice Address - Country:US
Practice Address - Phone:847-570-1463
Practice Address - Fax:847-733-5108
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.006575363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI61238OtherDEAN HEALTH INSURANCE
WI61238OtherDEAN HEALTH INSURANCE