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General NPI Number Information
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NPI Number | 1336316603
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Entity Type | Individual
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Provider Name | KATHLEEN ANN KOCIAK RN, MS, GNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 2850 W 95TH ST SUITE 106
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2735
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Country | US
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Telephone | 708-425-9399
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 W 87TH ST
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City | CHICAGO
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State | IL
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Zip | 60652-3831
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Country | US
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Telephone | 773-863-7503
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 209-004338
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License Number State | IL
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