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NPI Code Detail

MEDICARE: BEATA KACZKOWSKI NP-C

MEDICARE: BEATA KACZKOWSKI NP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner209.016308IL

General Provider Information

NPI Number : 1548787831
Entity Type Code : Individual
Provider Name (Legal Business Name) : BEATA KACZKOWSKI NP-C
Provider Business Mailing Address
First Line : 2020 E GRAND AVE
Second Line :
City : LINDENHURST
State : IL
Zip : 60046-9069
Country : US
Telephone Number : 866-389-2727
Fax Number :
Provider Business Practice Location Address
First Line : 2020 E GRAND AVE
Second Line :
City : LINDENHURST
State : IL
Zip : 60046-9069
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2017
Last Update Date : 08/28/2017

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