Healthcare Provider Details

I. General information

NPI: 1437827847
Provider Name (Legal Business Name): KAROLINA NIEMIEC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 S GLADSTONE AVE
AURORA IL
60506-4892
US

IV. Provider business mailing address

288 CARTER AVE
WOOD DALE IL
60191-1980
US

V. Phone/Fax

Practice location:
  • Phone: 630-892-6431
  • Fax:
Mailing address:
  • Phone: 224-456-5456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: