Healthcare Provider Details

I. General information

NPI: 1891957825
Provider Name (Legal Business Name): BEATA BORAWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHILDRENS PLZ
CHICAGO IL
60614-3363
US

IV. Provider business mailing address

5119 W WILSON AVE
CHICAGO IL
60630-3905
US

V. Phone/Fax

Practice location:
  • Phone: 773-327-3966
  • Fax: 773-327-3937
Mailing address:
  • Phone: 773-685-9418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209.007121
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: