Provider Demographics
NPI:1215781265
Name:PEDERSEN, KARA (RN, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:KARA
Middle Name:
Last Name:PEDERSEN
Suffix:
Gender:
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2837 W ARMITAGE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6852
Mailing Address - Country:US
Mailing Address - Phone:714-380-9195
Mailing Address - Fax:
Practice Address - Street 1:4417 W DIVERSEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-1923
Practice Address - Country:US
Practice Address - Phone:773-377-7736
Practice Address - Fax:815-642-5723
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.434471163W00000X
IL209.031005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse