Healthcare Provider Details

I. General information

NPI: 1477172005
Provider Name (Legal Business Name): KELSEY ANN BRZUSZKIEWICZ NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST STE 155
CHICAGO IL
60612-3849
US

IV. Provider business mailing address

1725 W HARRISON ST STE 155
CHICAGO IL
60612-3849
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-4300
  • Fax: 312-942-6685
Mailing address:
  • Phone: 312-942-4300
  • Fax: 312-942-6685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.021875
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.455907
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: