Provider Demographics
NPI:1336923945
Name:KORONKOWSKI, MICHALINA CHRISTINA
Entity Type:Individual
Prefix:
First Name:MICHALINA
Middle Name:CHRISTINA
Last Name:KORONKOWSKI
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 1:1714 RAWSON AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-1848
Mailing Address - Country:US
Mailing Address - Phone:414-750-5268
Mailing Address - Fax:
Practice Address - Street 1:1740 W TAYLOR ST STE 3200W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:312-996-4050
Practice Address - Fax:312-996-4019
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209028538367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered