Provider Demographics
NPI:1780085506
Name:HANLEY, KATHERINE ANNE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:ANNE
Last Name:HANLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 CHESHIRE CT
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-8547
Mailing Address - Country:US
Mailing Address - Phone:630-379-9351
Mailing Address - Fax:
Practice Address - Street 1:675 N SAINT CLAIR ST STE 17-250
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5962
Practice Address - Country:US
Practice Address - Phone:312-695-5620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085005148363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical