Provider Demographics
NPI:1114720141
Name:BREITENSTEIN, KATELYN (FNP)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:BREITENSTEIN
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:STINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-1318
Mailing Address - Country:US
Mailing Address - Phone:847-641-0288
Mailing Address - Fax:
Practice Address - Street 1:224 W CLARENDON DR
Practice Address - Street 2:
Practice Address - City:ROUND LAKE BEACH
Practice Address - State:IL
Practice Address - Zip Code:60073-1896
Practice Address - Country:US
Practice Address - Phone:847-377-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209030992363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily