Provider Demographics
NPI:1124205240
Name:OLESZKOWICZ, KRISTIN M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:M
Last Name:OLESZKOWICZ
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:EVANSTON NORTHWESTERN HEALTHCARE
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201
Mailing Address - Country:US
Mailing Address - Phone:847-570-1644
Mailing Address - Fax:847-733-5315
Practice Address - Street 1:777 PARK AVE W
Practice Address - Street 2:HIGHLAND PARK HOSPITAL
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2433
Practice Address - Country:US
Practice Address - Phone:847-570-1644
Practice Address - Fax:847-733-5315
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085003119363AS0400X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085003119OtherSTATE LICENSE