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General NPI Number Information
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NPI Number | 1982014841
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Entity Type | Organization
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Legal Business Name | NONE
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Dates
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Enumeration Date | 04/30/2014
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Last Update Date | 04/30/2014
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Provider Practice Location Address
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Address Line | 2323 W 114TH ST
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City | CHICAGO
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State | IL
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Zip | 60643-4108
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Country | US
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Telephone | 773-802-3940
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Fax |
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Provider Business Mailing Address
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Address Line | 2323 W 114TH ST
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City | CHICAGO
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State | IL
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Zip | 60643-4108
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | RNFA
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Name | ZACHARY KOSYLA
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Credential | RN,BSN,CNOR,RNFA
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Telephone | 773-802-3940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 041296369
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License Number State | IL
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