Provider Demographics
NPI:1124204565
Name:SZKLINIARZ, KELLY MAUREEN (APN)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MAUREEN
Last Name:SZKLINIARZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:MAVREEN
Other - Last Name:GAUGHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:2545 S. KING DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616
Mailing Address - Country:US
Mailing Address - Phone:312-808-4575
Mailing Address - Fax:312-808-4575
Practice Address - Street 1:2545 S. KING DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616
Practice Address - Country:US
Practice Address - Phone:312-808-4575
Practice Address - Fax:312-808-4575
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-005610363LA2200X
IL209.005610363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ49611Medicare UPIN