Healthcare Provider Details

I. General information

NPI: 1982462206
Provider Name (Legal Business Name): KAROLINA ZOFIA KOWALCZYK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 S HUMPHREY AVE
OAK PARK IL
60302-3527
US

IV. Provider business mailing address

7416 S COUNTY LINE RD STE A
BURR RIDGE IL
60527-7961
US

V. Phone/Fax

Practice location:
  • Phone: 773-879-5311
  • Fax:
Mailing address:
  • Phone: 630-655-3204
  • Fax: 630-786-3141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209027550
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: