Provider Demographics
NPI:1467648683
Name:SPRINGER, KATIE R (PA-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:R
Last Name:SPRINGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:P
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 N WESTMORELAND RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1687
Mailing Address - Country:US
Mailing Address - Phone:847-535-7647
Mailing Address - Fax:224-271-3310
Practice Address - Street 1:800 N WESTMORELAND RD STE 201
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045
Practice Address - Country:US
Practice Address - Phone:847-535-7647
Practice Address - Fax:224-271-3310
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001564363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical