Katherine Eydelman, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209018063 Issued in IL

Practice address

4318 S State St
Chicago, IL 60609-3701

Phone

(773) 285-9304

Fax

(773) 564-3501

NPI assigned

Nov 4, 2015

Last updated

Oct 17, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Katherine Tonnies Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1446595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539734400000",
    "number": "1114390788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4318 S STATE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606093701",
            "telephone_number": "773-285-9304",
            "fax_number": "773-564-3501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4318 S STATE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606093701",
            "telephone_number": "773-285-9304",
            "fax_number": "773-564-3501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EYDELMAN",
        "first_name": "KATHERINE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-04",
        "last_updated": "2018-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209018063",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NV",
            "license": "APRN002070",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114390788",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHERINE",
            "last_name": "TONNIES",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.