Provider Demographics
NPI:1881846228
Name:BONDAROWICZ, DOROTHY MARIA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:MARIA
Last Name:BONDAROWICZ
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MS
Other - First Name:DOROTHY
Other - Middle Name:MARIA
Other - Last Name:BONDAROWICZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:1100 W CERMAK RD
Mailing Address - Street 2:STE C119
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-4546
Mailing Address - Country:US
Mailing Address - Phone:312-243-2223
Mailing Address - Fax:312-243-2227
Practice Address - Street 1:199 S ADDISON RD STE 105
Practice Address - Street 2:
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191-1978
Practice Address - Country:US
Practice Address - Phone:630-766-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005177363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health