Healthcare Provider Details

I. General information

NPI: 1679908875
Provider Name (Legal Business Name): HEIDI KOLODZIEJCZYK APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST STE 1600
CHICAGO IL
60611-3111
US

IV. Provider business mailing address

259 E ERIE ST STE 1600
CHICAGO IL
60611-3111
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-5620
  • Fax: 312-695-0042
Mailing address:
  • Phone: 312-695-5620
  • Fax: 312-695-0042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number277000576
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277000576
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: