Healthcare Provider Details

I. General information

NPI: 1013273374
Provider Name (Legal Business Name): MARY PATRICIA KO APN NURSE PRACTITION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY PATRICIA BRAUNSCHWEIG NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 N. CALIFORNIA AVE
CHICAGO IL
60618
US

IV. Provider business mailing address

1333 BURR RIDGE PKWY SUITE 200
BURR RIDGE IL
60527
US

V. Phone/Fax

Practice location:
  • Phone: 773-478-4222
  • Fax: 773-478-7867
Mailing address:
  • Phone: 630-832-1775
  • Fax: 630-832-3078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP60270270
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: