Provider Demographics
NPI:1891387783
Name:ROTELLA, KATHERINE (APRN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:ROTELLA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 SHERIDAN CIR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-9273
Mailing Address - Country:US
Mailing Address - Phone:440-856-6667
Mailing Address - Fax:
Practice Address - Street 1:1310 N MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-1397
Practice Address - Country:US
Practice Address - Phone:815-786-8484
Practice Address - Fax:815-786-7153
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022847363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner