Healthcare Provider Details

I. General information

NPI: 1114774676
Provider Name (Legal Business Name): KAROLINA ADAIR APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAROLINA KIELBANIA

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST STE 1950
CHICAGO IL
60611-3907
US

IV. Provider business mailing address

259 E ERIE ST STE 1950
CHICAGO IL
60611-3907
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-7950
  • Fax: 312-695-5747
Mailing address:
  • Phone: 312-695-7950
  • Fax: 312-695-5747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209030014
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.454530
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: