Healthcare Provider Details

I. General information

NPI: 1366862005
Provider Name (Legal Business Name): ALISON BARTNICKI AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

1730 45TH AVE
MUNSTER IN
46321-3915
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209-011437
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number71005944A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: