=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770893158
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLENE BIELECKI ANP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2010
-----------------------------------------------------
Last Update Date | 02/05/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12251 S 80TH AVE
-----------------------------------------------------
City | PALOS HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60463-1256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-257-1111
-----------------------------------------------------
Fax | 630-257-1115
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12251 S 80TH AVE MED STAFF OFFICE SUITE 1630
-----------------------------------------------------
City | PALOS HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60463-1256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-923-5173
-----------------------------------------------------
Fax | 708-923-5018
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 041246820
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 209.008359
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------