=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689391039
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AGATHA LEWANDOWSKA GIANNESE FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2022
-----------------------------------------------------
Last Update Date | 05/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2960 N LAKE SHORE DR
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60657-5600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-345-5300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2500 W HIGGINS RD STE 1040
-----------------------------------------------------
City | HOFFMAN ESTATES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60169-2049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-296-2141
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 209026876
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 277004230
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------