Healthcare Provider Details

I. General information

NPI: 1760346613
Provider Name (Legal Business Name): MAGDALENA A WOZIWODA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 W DEMPSTER ST
PARK RIDGE IL
60068-1143
US

IV. Provider business mailing address

119 N HORNER LN
MOUNT PROSPECT IL
60056-2606
US

V. Phone/Fax

Practice location:
  • Phone: 847-723-6520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number041496766
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: