Healthcare Provider Details

I. General information

NPI: 1750853180
Provider Name (Legal Business Name): KRYSTYNA OLENIACZ-MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/25/2018
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 W 95TH ST
OAK LAWN IL
60453
US

IV. Provider business mailing address

1395 NW 167TH ST
MIAMI GARDENS FL
33169-5710
US

V. Phone/Fax

Practice location:
  • Phone: 708-261-0831
  • Fax:
Mailing address:
  • Phone: 305-628-6117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.018542
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: