Provider Demographics
NPI:1548644545
Name:VANDERMAST, KATELYN MARIE (APN, FNP-BC, NP-C)
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:MARIE
Last Name:VANDERMAST
Suffix:
Gender:F
Credentials:APN, FNP-BC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1850 GATEWAY DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3192
Mailing Address - Country:US
Mailing Address - Phone:815-766-7021
Mailing Address - Fax:815-758-5690
Practice Address - Street 1:1850 GATEWAY DR STE 201
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3192
Practice Address - Country:US
Practice Address - Phone:815-766-7021
Practice Address - Fax:815-758-5690
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-390433163W00000X
IL209013007363LA2100X, 363LX0001X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology