Provider Demographics
NPI:1639413974
Name:PELKA, KIRSTEN ELIZABETH (NP)
Entity Type:Individual
Prefix:MISS
First Name:KIRSTEN
Middle Name:ELIZABETH
Last Name:PELKA
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 1:5425 W ADDISON ST
Mailing Address - Street 2:OLD IRVING PARK COMMUNITY CLINIC
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-3203
Mailing Address - Country:US
Mailing Address - Phone:773-427-0298
Mailing Address - Fax:
Practice Address - Street 1:5425 W ADDISON ST
Practice Address - Street 2:OLD IRVING PARK COMMUNITY CLINIC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-3203
Practice Address - Country:US
Practice Address - Phone:773-427-0298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.009656363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health