Healthcare Provider Details

I. General information

NPI: 1710222344
Provider Name (Legal Business Name): KATARZYNA ANNA KOZIOL APN, ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3919 W FOSTER AVE
CHICAGO IL
60625-6056
US

IV. Provider business mailing address

3919 W FOSTER AVE
CHICAGO IL
60625-6056
US

V. Phone/Fax

Practice location:
  • Phone: 773-588-9500
  • Fax: 773-279-3555
Mailing address:
  • Phone: 773-588-9500
  • Fax: 773-279-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209009579
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209.009579
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: