Healthcare Provider Details

I. General information

NPI: 1194042283
Provider Name (Legal Business Name): JOLYN MARIE KOWALLIS APN,NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOLYN MARIE BERG APN,NP-C

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 BARRINGTON RD DOCTORS BUILDING #3-SUITE 1200
HOFFMAN ESTATES IL
60169-1019
US

IV. Provider business mailing address

1555 BARRINGTON RD DOCTORS BUILDING #3-SUITE 1200
HOFFMAN ESTATES IL
60169-1019
US

V. Phone/Fax

Practice location:
  • Phone: 847-885-4100
  • Fax: 847-885-4199
Mailing address:
  • Phone: 847-885-4100
  • Fax: 847-885-4199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209008090
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: