Healthcare Provider Details

I. General information

NPI: 1497016364
Provider Name (Legal Business Name): AGNIESZKA ALBERSKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N. HOOKER STREET SUITE 301
CHICAGO IL
60642-4633
US

IV. Provider business mailing address

1010 N. HOOKER STREET SUITE 301
CHICAGO IL
60642-4633
US

V. Phone/Fax

Practice location:
  • Phone: 312-943-3600
  • Fax:
Mailing address:
  • Phone: 312-943-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number043114747
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: