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Individual

KATHY WAJDA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
3880 SALEM LAKE DR STE F, LONG GROVE, IL 60047-5292
(847) 719-2220
(847) 719-2265
Mailing address
3880 SALEM LAKE DR STE F, LONG GROVE, IL 60047-5292
(847) 719-2220
(847) 719-2265

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
209016851
IL
363LF0000X
Family Nurse Practitioner
209-016851
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
209016851
IL
Enumeration date
05/23/2018
Last updated
12/13/2022
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