Provider Demographics
NPI:1689136319
Name:BORKOWSKI, BRITTANY SUE
Entity Type:Individual
Prefix:MS
First Name:BRITTANY
Middle Name:SUE
Last Name:BORKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 W PIERCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2250
Mailing Address - Country:US
Mailing Address - Phone:312-513-4005
Mailing Address - Fax:
Practice Address - Street 1:5841 S MARYLAND AVE # W700
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1443
Practice Address - Country:US
Practice Address - Phone:312-513-4005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018022363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209018022OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION