Provider Demographics
NPI:1821500398
Name:KAWECKI, KAMILLA KRYSTYNA (NP)
Entity Type:Individual
Prefix:
First Name:KAMILLA
Middle Name:KRYSTYNA
Last Name:KAWECKI
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 1:708 N SILVER LEAF LN
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-5267
Mailing Address - Country:US
Mailing Address - Phone:224-381-4752
Mailing Address - Fax:
Practice Address - Street 1:2534 ELIM AVE
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-2661
Practice Address - Country:US
Practice Address - Phone:847-746-8435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016619363LF0000X
IL277000405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily