Basic Information
Provider Information
NPI: 1174616320
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GIANAN
FirstName: CATHERINE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
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OtherLastNameType:  
Mailing Information
Address1: PO BOX 74100264
Address2:  
City: CHICAGO
State: IL
PostalCode: 606740264
CountryCode: US
TelephoneNumber: 8159426323
FaxNumber: 7792105541
Practice Location
Address1: 3033 W JEFFERSON ST STE 201
Address2:  
City: JOLIET
State: IL
PostalCode: 604355252
CountryCode: US
TelephoneNumber: 8159426323
FaxNumber: 7792105541
Other Information
ProviderEnumerationDate: 10/02/2006
LastUpdateDate: 02/18/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/18/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X209006128ILY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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