Provider Demographics
NPI:1891028973
Name:BICKEL, KATHERINE ELISE (RN, MSN)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ELISE
Last Name:BICKEL
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3248 W BELLE PLAINE AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-2302
Mailing Address - Country:US
Mailing Address - Phone:262-227-0417
Mailing Address - Fax:
Practice Address - Street 1:3204 W 26TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4031
Practice Address - Country:US
Practice Address - Phone:773-927-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012468041426443363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care