Healthcare Provider Details

I. General information

NPI: 1780846931
Provider Name (Legal Business Name): SANDRA T SZCZECINSKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 S 5TH AVE
HINES IL
60141-3030
US

IV. Provider business mailing address

6386 NEW ALBANY RD
LISLE IL
60532-3235
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-8387
  • Fax: 708-202-4146
Mailing address:
  • Phone: 630-416-7588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041248203
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: