Provider Demographics
NPI:1053397687
Name:GIETL, KATHRYN A (RNC,WHNP)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:A
Last Name:GIETL
Suffix:
Gender:F
Credentials:RNC,WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W CARPENTER ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-4902
Mailing Address - Country:US
Mailing Address - Phone:217-525-0210
Mailing Address - Fax:217-525-1007
Practice Address - Street 1:350 W CARPENTER ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-4902
Practice Address - Country:US
Practice Address - Phone:217-525-0210
Practice Address - Fax:217-525-1007
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL574080Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER