Basic Information
| Provider Information | |||||||||
| NPI: | 1316189343 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOWALCZYK | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | APN, NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4201 WINFIELD RD FL 4 | ||||||||
| Address2: | |||||||||
| City: | WARRENVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605554025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3312216377 | ||||||||
| FaxNumber: | 3312212357 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 W LAKE ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | ADDISON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601012500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3312219001 | ||||||||
| FaxNumber: | 3312213971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2009 | ||||||||
| LastUpdateDate: | 05/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209.007542 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.