Healthcare Provider Details

I. General information

NPI: 1780192245
Provider Name (Legal Business Name): KRISTEN SZEWCZYK PNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N LOOMIS ST
CHICAGO IL
60607-1111
US

IV. Provider business mailing address

705 W WRIGHTWOOD AVE APT 3E
CHICAGO IL
60614-8948
US

V. Phone/Fax

Practice location:
  • Phone: 773-254-4030
  • Fax:
Mailing address:
  • Phone: 415-516-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number209016017
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: