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General NPI Number Information
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NPI Number | 1164068730
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Entity Type | Individual
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Provider Name | ALEXIS GASIOROWSKI APRN
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Gender | Female
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Dates
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Enumeration Date | 11/19/2019
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 737 N MICHIGAN AVE STE 870
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City | CHICAGO
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State | IL
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Zip | 60611-2615
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Country | US
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Telephone | 312-030-0353
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Fax |
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Provider Business Mailing Address
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Address Line | 2828 N TALMAN AVE UNIT A
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City | CHICAGO
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State | IL
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Zip | 60618-7829
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Country | US
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Telephone | 815-353-4726
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 209.020445
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License Number State | IL
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