Healthcare Provider Details

I. General information

NPI: 1861015448
Provider Name (Legal Business Name): RENATA MARIA JANKOWSKA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2020
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 N MILWAUKEE AVE
NILES IL
60714-3159
US

IV. Provider business mailing address

4131 N YALE AVE
ARLINGTON HTS IL
60004-7924
US

V. Phone/Fax

Practice location:
  • Phone: 847-595-1594
  • Fax:
Mailing address:
  • Phone: 224-381-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209021246
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1035881
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number209021246
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: