Provider Demographics
NPI:1558630616
Name:KLIONSKY, SUPRIYA N (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:SUPRIYA
Middle Name:N
Last Name:KLIONSKY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 W DUNDEE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4055
Mailing Address - Country:US
Mailing Address - Phone:847-818-7700
Mailing Address - Fax:
Practice Address - Street 1:1401 W DUNDEE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-4055
Practice Address - Country:US
Practice Address - Phone:847-818-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.312898363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily