Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 067298 | MO |
N | 363L00000X | Nurse Practitioner | 209002894 | IL |
Y | 363LA2200X | Nurse Practitioner - Adult Health | 067298 | MO |
N | 363LA2200X | Nurse Practitioner - Adult Health | 209002894 | IL |
N | 363LW0102X | Nurse Practitioner - Women's Health | 209002894 | IL |
NPI | 1043376650 |
---|---|
Provider Name | Katherine Collins-Whittaker |
First Address | Alton, IL 62002-6321 |
Second Address | Alton, IL 62002-6321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 15/05/2018 |