Healthcare Provider Details

I. General information

NPI: 1003617796
Provider Name (Legal Business Name): KRISTIN ELISE KOWALESKI APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N WESTMORELAND RD STE 112
LAKE FOREST IL
60045-1680
US

IV. Provider business mailing address

900 N WESTMORELAND RD STE 112
LAKE FOREST IL
60045-1680
US

V. Phone/Fax

Practice location:
  • Phone: 847-535-7057
  • Fax: 847-615-2260
Mailing address:
  • Phone: 847-535-7057
  • Fax: 847-615-2260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209034836
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPN.100006559-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: