Healthcare Provider Details

I. General information

NPI: 1245739515
Provider Name (Legal Business Name): URSZULA WYSOCKA-PIESIEWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W TAYLOR ST STE 3F
CHICAGO IL
60612-4795
US

IV. Provider business mailing address

6264 S GULLIKSON RD APT 4A
CHICAGO IL
60638-3943
US

V. Phone/Fax

Practice location:
  • Phone: 312-355-4300
  • Fax:
Mailing address:
  • Phone: 773-577-4065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.015969
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: