Provider Demographics
NPI:1255647962
Name:SCHAFER, KATHY J (RN, MSN, WHNP)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:J
Last Name:SCHAFER
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Gender:F
Credentials:RN, MSN, WHNP
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Other - First Name:
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Mailing Address - Street 1:1 MEMORIAL DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-6303
Mailing Address - Country:US
Mailing Address - Phone:217-875-5545
Mailing Address - Fax:217-875-4680
Practice Address - Street 1:1 MEMORIAL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6303
Practice Address - Country:US
Practice Address - Phone:217-875-5545
Practice Address - Fax:217-875-4680
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209.008352363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology