Provider Demographics
NPI:1174181903
Name:DAVIS, KATHERINE RENEE (DNP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:RENEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:PULEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 746715
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6715
Mailing Address - Country:US
Mailing Address - Phone:773-242-2299
Mailing Address - Fax:773-830-1920
Practice Address - Street 1:3433 W MADISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-2895
Practice Address - Country:US
Practice Address - Phone:773-242-2299
Practice Address - Fax:773-830-1920
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.019181363L00000X
WI11400-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner