Provider Demographics
NPI:1164205324
Name:SZACILO, DOMINIKA (APN)
Entity Type:Individual
Prefix:
First Name:DOMINIKA
Middle Name:
Last Name:SZACILO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-4780
Mailing Address - Country:US
Mailing Address - Phone:630-357-6540
Mailing Address - Fax:630-357-6435
Practice Address - Street 1:3 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-4780
Practice Address - Country:US
Practice Address - Phone:630-357-6540
Practice Address - Fax:630-357-6435
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209027570363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health