Provider Demographics
NPI:1699857243
Name:STASZCUK, ROWEINE Q (NP)
Entity Type:Individual
Prefix:MRS
First Name:ROWEINE
Middle Name:Q
Last Name:STASZCUK
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 1:10 S KEDZIE AVE
Mailing Address - Street 2:RM 206
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-2706
Mailing Address - Country:US
Mailing Address - Phone:773-775-1589
Mailing Address - Fax:
Practice Address - Street 1:10 S KEDZIE AVE
Practice Address - Street 2:ROOM 206
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-2706
Practice Address - Country:US
Practice Address - Phone:312-746-6833
Practice Address - Fax:312-746-9049
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003325363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health