Provider Demographics
NPI:1124412168
Name:DCRUZ, KATIE GENEVIEVE (AGNP-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:GENEVIEVE
Last Name:DCRUZ
Suffix:
Gender:
Credentials:AGNP-C
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:GENEVIEVE
Other - Last Name:RAHOI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AGNP-C
Mailing Address - Street 1:630 E NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2127
Mailing Address - Country:US
Mailing Address - Phone:630-581-7288
Mailing Address - Fax:
Practice Address - Street 1:332 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-4434
Practice Address - Country:US
Practice Address - Phone:855-229-2191
Practice Address - Fax:312-579-0467
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041395058163W00000X
IL209012527363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse