Basic Information
| Provider Information | |||||||||
| NPI: | 1093423832 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TITE | ||||||||
| FirstName: | KATHRYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 RED BUD CT | ||||||||
| Address2: | |||||||||
| City: | MAHOMET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618539292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2177224218 | ||||||||
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| Practice Location | |||||||||
| Address1: | 108 ROBINSON ST | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618328515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174428611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2022 | ||||||||
| LastUpdateDate: | 11/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LS0200X | 041428985 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | School |
No ID Information.