Provider Demographics
NPI:1316510639
Name:MASLAR, KATHERINE BALOS
Entity type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:BALOS
Last Name:MASLAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13180 FOX HILL DR
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-8193
Mailing Address - Country:US
Mailing Address - Phone:708-721-6830
Mailing Address - Fax:
Practice Address - Street 1:1010 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-6135
Practice Address - Country:US
Practice Address - Phone:630-323-0119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021141363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care