Provider Demographics
NPI:1174537526
Name:PORONSKY, CATHLIN B (RN, APN)
Entity type:Individual
Prefix:MRS
First Name:CATHLIN
Middle Name:B
Last Name:PORONSKY
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
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Mailing Address - Street 1:4808 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1703
Mailing Address - Country:US
Mailing Address - Phone:708-246-6051
Mailing Address - Fax:
Practice Address - Street 1:6400 W COLLEGE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1785
Practice Address - Country:US
Practice Address - Phone:708-389-5555
Practice Address - Fax:708-389-8814
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP02934Medicare UPIN