Healthcare Provider Details

I. General information

NPI: 1952175994
Provider Name (Legal Business Name): JUSTIN KAPELINSKI APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 S WOOD ST
CHICAGO IL
60612-3747
US

IV. Provider business mailing address

1009 S WOOD ST
CHICAGO IL
60612-3747
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-6771
  • Fax:
Mailing address:
  • Phone: 708-216-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number209-028256
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209028256
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: