Healthcare Provider Details

I. General information

NPI: 1740031772
Provider Name (Legal Business Name): KATARZYNA CIESIELSKA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5635 W BELMONT AVE
CHICAGO IL
60634-4384
US

IV. Provider business mailing address

5635 W BELMONT AVE
CHICAGO IL
60634-4384
US

V. Phone/Fax

Practice location:
  • Phone: 773-736-1830
  • Fax: 773-622-8055
Mailing address:
  • Phone: 773-736-1830
  • Fax: 773-622-8055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.029074
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: