Provider Demographics
NPI:1336812668
Name:KUCZYNSKI, BOGUMILA KRYSTYNA
Entity Type:Individual
Prefix:
First Name:BOGUMILA
Middle Name:KRYSTYNA
Last Name:KUCZYNSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W SCHAUMBURG RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3464
Mailing Address - Country:US
Mailing Address - Phone:630-204-3317
Mailing Address - Fax:
Practice Address - Street 1:350 W SCHAUMBURG RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3464
Practice Address - Country:US
Practice Address - Phone:630-204-3317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL41273581163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology