Provider Demographics
NPI:1447567268
Name:CISZEK, RENATA KRYSTYNA (APN)
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:KRYSTYNA
Last Name:CISZEK
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 1:1901 S MEYERS ROAD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181
Mailing Address - Country:US
Mailing Address - Phone:630-873-7305
Mailing Address - Fax:630-416-3189
Practice Address - Street 1:429 N YORK ROAD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126
Practice Address - Country:US
Practice Address - Phone:630-782-4050
Practice Address - Fax:630-782-5021
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041337154363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner