1124412168 NPI number — KATIE GENEVIEVE DCRUZ AGNP-C

Table of content: KATIE GENEVIEVE DCRUZ AGNP-C (NPI 1124412168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124412168 NPI number — KATIE GENEVIEVE DCRUZ AGNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DCRUZ
Provider First Name:
KATIE
Provider Middle Name:
GENEVIEVE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AGNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAHOI
Provider Other First Name:
KATIE
Provider Other Middle Name:
GENEVIEVE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124412168
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13900 RIVERPORT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARYLAND HEIGHTS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63043-4804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-229-2177
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
332 S MICHIGAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60604-4434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-229-2191
Provider Business Practice Location Address Fax Number:
312-579-0467
Provider Enumeration Date:
03/27/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  2024044706 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LG0600X , with the licence number: 209012527 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)