Provider Demographics
NPI:1194042283
Name:KOWALLIS, JOLYN MARIE (APN,NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JOLYN
Middle Name:MARIE
Last Name:KOWALLIS
Suffix:
Gender:F
Credentials:APN,NP-C
Other - Prefix:MRS
Other - First Name:JOLYN
Other - Middle Name:MARIE
Other - Last Name:BERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN,NP-C
Mailing Address - Street 1:1555 BARRINGTON RD
Mailing Address - Street 2:DOCTORS BUILDING #3-SUITE 1200
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1019
Mailing Address - Country:US
Mailing Address - Phone:847-885-4100
Mailing Address - Fax:847-885-4199
Practice Address - Street 1:1555 BARRINGTON RD
Practice Address - Street 2:DOCTORS BUILDING #3-SUITE 1200
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1019
Practice Address - Country:US
Practice Address - Phone:847-885-4100
Practice Address - Fax:847-885-4199
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008090363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner