Healthcare Provider Details

I. General information

NPI: 1447567268
Provider Name (Legal Business Name): RENATA KRYSTYNA CISZEK APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 N YORK ROAD
ELMHURST IL
60126
US

IV. Provider business mailing address

1901 S MEYERS ROAD SUITE 350
OAKBROOK TERRACE IL
60181
US

V. Phone/Fax

Practice location:
  • Phone: 630-782-4050
  • Fax: 630-782-5021
Mailing address:
  • Phone: 630-873-7305
  • Fax: 630-416-3189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number041337154
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number041337154
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: