Provider Demographics
NPI:1245691799
Name:CZERNECKI, DOROTA (APRN, CNP)
Entity type:Individual
Prefix:
First Name:DOROTA
Middle Name:
Last Name:CZERNECKI
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:DOROTA
Other - Middle Name:
Other - Last Name:MOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12255 S 80TH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1284
Mailing Address - Country:US
Mailing Address - Phone:708-827-2021
Mailing Address - Fax:708-827-2241
Practice Address - Street 1:12255 S 80TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1284
Practice Address - Country:US
Practice Address - Phone:708-827-2021
Practice Address - Fax:708-827-2241
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014026363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care