Healthcare Provider Details

I. General information

NPI: 1700327558
Provider Name (Legal Business Name): KIRSTEN GORNICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRSTEN ELISE PACHECO CNM, APN

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 S ARLINGTON HEIGHTS RD
ARLINGTON HEIGHTS IL
60005-1929
US

IV. Provider business mailing address

216 S ARLINGTON HEIGHTS RD
ARLINGTON HEIGHTS IL
60005-1929
US

V. Phone/Fax

Practice location:
  • Phone: 847-221-4400
  • Fax: 847-221-4465
Mailing address:
  • Phone: 847-221-4400
  • Fax: 847-221-4465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209.015513
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: