Provider Demographics
NPI:1578960969
Name:WILLIAMS, NASTASSJA (APN)
Entity Type:Individual
Prefix:
First Name:NASTASSJA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:NASTASSJA
Other - Middle Name:
Other - Last Name:LUKASIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:259. E. ERIE LAVIN PAVILION 16TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-695-5620
Mailing Address - Fax:312-695-7095
Practice Address - Street 1:259 E. ERIE LAVIN PAVILION 16TH FLOOR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-695-5620
Practice Address - Fax:312-695-7095
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.012242363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily