Provider Demographics
NPI:1710739370
Name:PTAK, PATRYCJA ANNA (BSN, RNC-NIC, IBCLC)
Entity Type:Individual
Prefix:MISS
First Name:PATRYCJA
Middle Name:ANNA
Last Name:PTAK
Suffix:
Gender:F
Credentials:BSN, RNC-NIC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5803 N CAMPBELL AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-5445
Mailing Address - Country:US
Mailing Address - Phone:773-220-4973
Mailing Address - Fax:
Practice Address - Street 1:5803 N CAMPBELL AVE APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-5445
Practice Address - Country:US
Practice Address - Phone:773-220-4973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILL-56770163WL0100X
IL041345461163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant