Provider Demographics
NPI:1275872467
Name:PIWKO-MATENKO, KAROLINA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KAROLINA
Middle Name:
Last Name:PIWKO-MATENKO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KAROLINA
Other - Middle Name:
Other - Last Name:PIWKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1333 BUTTERFIELD RD 130
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5641
Mailing Address - Country:US
Mailing Address - Phone:630-371-0133
Mailing Address - Fax:630-371-0138
Practice Address - Street 1:345 EXECUTIVE PKWY
Practice Address - Street 2:STE D4
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5340
Practice Address - Country:US
Practice Address - Phone:270-554-5114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily