MEDICARE: SYLWIA POTOCZNY DNP, AGPCNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	209.022965	IL

General Provider Information

NPI Number	:	1568057347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYLWIA POTOCZNY DNP, AGPCNP-BC

Provider Business Mailing Address
First Line	:	545 N DEARBORN ST APT 3403
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-7934
Country	:	US
Telephone Number	:	630-400-6939
Fax Number	:

Provider Business Practice Location Address
First Line	:	545 N DEARBORN ST APT 3403
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-7934
Country	:	US
Telephone Number	:	630-400-6939
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2021
Last Update Date	:	03/04/2021

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