Healthcare Provider Details

I. General information

NPI: 1780594747
Provider Name (Legal Business Name): KIA LYNN CZUPRYNSKI LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W MAIN ST
MARION IL
62959-1188
US

IV. Provider business mailing address

408 N PARKHILL ST
WEST FRANKFORT IL
62896-1952
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-5311
  • Fax:
Mailing address:
  • Phone: 618-997-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number043127264
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: