Provider Demographics
NPI:1508186826
Name:SULIK, ALEXANDRA (NP)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:
Last Name:SULIK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6504 JOLIET RD
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-4795
Mailing Address - Country:US
Mailing Address - Phone:815-708-0382
Mailing Address - Fax:779-210-4583
Practice Address - Street 1:6504 JOLIET RD STE A
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-4796
Practice Address - Country:US
Practice Address - Phone:708-565-9840
Practice Address - Fax:708-639-4349
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.008166363LA2200X
IL277000004363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health