Provider Demographics
NPI:1861823692
Name:ANTUNOVICH, KATHLEEN S (NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:S
Last Name:ANTUNOVICH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:S
Other - Last Name:ANTUNOVICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:977 N OAKLAWN AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1045
Mailing Address - Country:US
Mailing Address - Phone:630-832-1775
Mailing Address - Fax:630-832-3078
Practice Address - Street 1:977 N OAKLAWN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-1045
Practice Address - Country:US
Practice Address - Phone:630-832-1775
Practice Address - Fax:630-832-3078
Is Sole Proprietor?:No
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-001181363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health