Healthcare Provider Details

I. General information

NPI: 1326286535
Provider Name (Legal Business Name): ANITA MARIE KROLCZYK CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 S PROMONTORY DR
CHICAGO IL
60649-1003
US

IV. Provider business mailing address

903 MARYKNOLL CIR
GLEN ELLYN IL
60137-6139
US

V. Phone/Fax

Practice location:
  • Phone: 773-363-6700
  • Fax: 773-363-0323
Mailing address:
  • Phone: 630-858-8702
  • Fax: 630-858-2135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209007078
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: