Provider Demographics
NPI:1972684066
Name:WODZINSKI, VALERIE (RN, MS)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:WODZINSKI
Suffix:
Gender:F
Credentials:RN, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 NORTHGATE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1640
Mailing Address - Country:US
Mailing Address - Phone:708-202-7168
Mailing Address - Fax:
Practice Address - Street 1:119 NORTHGATE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60541
Practice Address - Country:US
Practice Address - Phone:708-202-7168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-005141364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology