Basic Information
| Provider Information | |||||||||
| NPI: | 1831669365 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZAJAC | ||||||||
| FirstName: | KRISTA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | APRN, CNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LOZANSKI | ||||||||
| OtherFirstName: | KRISTA | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1256 WATERFORD DR STE 230 | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605044511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309786204 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2088 OGDEN AVE STE 160 | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605044383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308516440 | ||||||||
| FaxNumber: | 6308517001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2018 | ||||||||
| LastUpdateDate: | 12/01/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 041.397282 | IL | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 209.018107 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 209018107 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.