Healthcare Provider Details

I. General information

NPI: 1548987126
Provider Name (Legal Business Name): LUIZA SIELSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S PROSPECT AVE FL 3
PARK RIDGE IL
60068-4037
US

IV. Provider business mailing address

222 S PROSPECT AVE FL 3
PARK RIDGE IL
60068-4037
US

V. Phone/Fax

Practice location:
  • Phone: 563-200-7894
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209027308
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041442419
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: