Provider Demographics
NPI:1245793488
Name:CZAPKO, BRIAN R (APN)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:R
Last Name:CZAPKO
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 N DIVISION ST STE 4D5E
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-3100
Mailing Address - Country:US
Mailing Address - Phone:815-431-3410
Mailing Address - Fax:815-431-3411
Practice Address - Street 1:1715 N DIVISION ST STE 4D5E
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-3100
Practice Address - Country:US
Practice Address - Phone:815-431-3410
Practice Address - Fax:815-431-3411
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017826363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner