Basic Information
| Provider Information | |||||||||
| NPI: | 1447567268 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CISZEK | ||||||||
| FirstName: | RENATA | ||||||||
| MiddleName: | KRYSTYNA | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 S MEYERS ROAD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | OAKBROOK TERRACE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308737305 | ||||||||
| FaxNumber: | 6304163189 | ||||||||
| Practice Location | |||||||||
| Address1: | 429 N YORK ROAD | ||||||||
| Address2: | |||||||||
| City: | ELMHURST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307824050 | ||||||||
| FaxNumber: | 6307825021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2010 | ||||||||
| LastUpdateDate: | 04/07/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 041337154 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 041337154 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.