Healthcare Provider Details

I. General information

NPI: 1275170995
Provider Name (Legal Business Name): MARIANA KAWALET
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2019
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W PARK ST
URBANA IL
61801-2529
US

IV. Provider business mailing address

2311 LOVIE LN
CHAMPAIGN IL
61822-4207
US

V. Phone/Fax

Practice location:
  • Phone: 217-326-0046
  • Fax: 217-326-1300
Mailing address:
  • Phone: 216-925-3326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: