Healthcare Provider Details

I. General information

NPI: 1083970552
Provider Name (Legal Business Name): ANITA MARIE KRAJECKI RNC-LRN, BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4043 STATE RT. 59 ABC MOMS, INC
NAPERVILLE IL
60564
US

IV. Provider business mailing address

2091 PRIMROSE LN
NAPERVILLE IL
60565-2872
US

V. Phone/Fax

Practice location:
  • Phone: 630-299-4909
  • Fax:
Mailing address:
  • Phone: 630-416-8478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number041158806
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: