Healthcare Provider Details

I. General information

NPI: 1356836217
Provider Name (Legal Business Name): DOROTHY S. KOZAKOWSKI, APRN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2018
Last Update Date: 06/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 REVERE DR STE 100
NORTHBROOK IL
60062-1590
US

IV. Provider business mailing address

PO BOX 506
NORTHBROOK IL
60065-0506
US

V. Phone/Fax

Practice location:
  • Phone: 224-306-1879
  • Fax: 847-919-6875
Mailing address:
  • Phone: 224-306-1879
  • Fax: 847-919-6875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DOROTHY KOZAKOWSKI
Title or Position: APN
Credential: APN
Phone: 224-306-1879