Basic Information
| Provider Information | |||||||||
| NPI: | 1477032316 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAGURO-ROBLEDO | ||||||||
| FirstName: | KATHELYN | ||||||||
| MiddleName: | SIM | ||||||||
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| Credential: | APN, MSN-FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2340 S EOLA RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605036410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306925190 | ||||||||
| FaxNumber: | 6306925185 | ||||||||
| Practice Location | |||||||||
| Address1: | 2340 S EOLA RD | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605036409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306925190 | ||||||||
| FaxNumber: | 6306925185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2018 | ||||||||
| LastUpdateDate: | 06/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209.017732 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.