Healthcare Provider Details

I. General information

NPI: 1407100381
Provider Name (Legal Business Name): EMILY MCREYNOLDS BARSZCZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY MCREYNOLDS FNP

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S YORK ST STE 2000
ELMHURST IL
60126-5634
US

IV. Provider business mailing address

4201 WINFIELD RD FL 3
WARRENVILLE IL
60555-4025
US

V. Phone/Fax

Practice location:
  • Phone: 331-221-9002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209009892
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209009892
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: