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General NPI Number Information
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NPI Number | 1245402965
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Entity Type | Organization
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Legal Business Name | ROCK VALLEY ADVANCED PAIN MANAGEMENT INC.
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 11/11/2008
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Provider Practice Location Address
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Address Line | 6550 E RIVERSIDE BLVD
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City | LOVES PARK
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State | IL
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Zip | 61111-4424
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Country | US
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Telephone | 815-316-1894
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Fax | 815-633-5141
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Provider Business Mailing Address
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Address Line | 6550 E RIVERSIDE BLVD
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City | LOVES PARK
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State | IL
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Zip | 61111-4424
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Country | US
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Telephone | 815-316-1894
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Fax | 815-633-5141
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Authorized Official
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Title or Position | OWNER
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Name | TAMARA L WOJCIECHOWSKI
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Credential | CRNA, FAAPM, APN
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Telephone | 815-316-1894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209001050
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License Number State | IL
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