Healthcare Provider Details

I. General information

NPI: 1073132007
Provider Name (Legal Business Name): PAULINA MICHALIK APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST STE 18-250
CHICAGO IL
60611-5980
US

IV. Provider business mailing address

675 N SAINT CLAIR ST STE 18-250
CHICAGO IL
60611-5980
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8624
  • Fax: 312-695-4741
Mailing address:
  • Phone: 312-695-8624
  • Fax: 312-695-4741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.471985
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041413256
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0027046
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209024528
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: