Healthcare Provider Details

I. General information

NPI: 1912225202
Provider Name (Legal Business Name): LILLA WOJCIECHOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LILLA SZUSTEK ANP-BC

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9125 S PULASKI RD
EVERGREEN PARK IL
60805-1441
US

IV. Provider business mailing address

9125 S PULASKI RD
EVERGREEN PARK IL
60805-1441
US

V. Phone/Fax

Practice location:
  • Phone: 708-422-7715
  • Fax: 708-422-7816
Mailing address:
  • Phone: 708-422-7715
  • Fax: 708-422-7816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209.008025
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: