Provider Demographics
NPI:1134996606
Name:RECZEK, BEATA (NP)
Entity type:Individual
Prefix:
First Name:BEATA
Middle Name:
Last Name:RECZEK
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 1:4647 W 103RD ST STE 2L
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4793
Mailing Address - Country:US
Mailing Address - Phone:708-952-0200
Mailing Address - Fax:708-952-0220
Practice Address - Street 1:4647 W 103RD ST STE 2L
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4793
Practice Address - Country:US
Practice Address - Phone:708-952-0200
Practice Address - Fax:708-952-0220
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209028837363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner