Healthcare Provider Details

I. General information

NPI: 1528985454
Provider Name (Legal Business Name): MICHELLE VICTORIA NIEDZWIEDZKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9357 LANDINGS LN
DES PLAINES IL
60016-5263
US

IV. Provider business mailing address

9357 LANDINGS LN
DES PLAINES IL
60016-5263
US

V. Phone/Fax

Practice location:
  • Phone: 773-842-1916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.506773
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: