Individual
KATHRYN GENSEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
420 NE GLEN OAK AVE STE 401, DEPT. OF PEDIATRICS, PEORIA, IL 61603-3168
(309) 624-9844
Mailing address
1 ILLINI DR, PEORIA, IL 61605-2576
(309) 671-8503
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
209004202
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07215036
BCBS
IL
01
—
IL01DK
JOHN DEERE
IL
Enumeration date
02/21/2006
Last updated
09/04/2013
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