Provider Demographics
NPI:1841847266
Name:KASPA, AGNES F
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:F
Last Name:KASPA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E CHESTNUT DR
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-1442
Mailing Address - Country:US
Mailing Address - Phone:847-962-9588
Mailing Address - Fax:
Practice Address - Street 1:7444 W WILSON AVE
Practice Address - Street 2:
Practice Address - City:HARWOOD HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60706-4500
Practice Address - Country:US
Practice Address - Phone:747-885-1818
Practice Address - Fax:708-695-5030
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.019655363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology