MEDICARE: NATALIA SUROWANIEC APN

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	363LF0000X	Family Nurse Practitioner	209.013494	IL

General Provider Information

NPI Number	:	1871967869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIA SUROWANIEC APN

Provider Business Mailing Address
First Line	:	906 WATERFORD LN
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-7235
Country	:	US
Telephone Number	:	847-834-5286
Fax Number	:

Provider Business Practice Location Address
First Line	:	3204 N OAK PARK AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-4640
Country	:	US
Telephone Number	:	773-736-3131
Fax Number	:

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

Provider Enumeration Date	:	11/14/2015
Last Update Date	:	11/14/2015

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