Individual
KATHRYN M ENDRESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1701 W GARDEN ST, PEORIA, IL 61605-3531
(309) 680-7600
(309) 680-7686
Mailing address
1701 W GARDEN ST, PEORIA, IL 61605-3531
(309) 680-7600
(309) 680-7686
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209-011751
IL
363LF0000X
Family Nurse Practitioner
Primary
F06141327
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209-011751
IL LICENSE
IL
01
—
309-007528
IL CONTROLLED SUBSTANCE LICENSE
IL
Enumeration date
08/27/2014
Last updated
02/05/2016
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