Provider Demographics
NPI:1356600993
Name:BRZOZOWSKI, LORAINE A (ACNP-BC)
Entity type:Individual
Prefix:
First Name:LORAINE
Middle Name:A
Last Name:BRZOZOWSKI
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 FRANCISCO TER
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2615
Mailing Address - Country:US
Mailing Address - Phone:708-383-9259
Mailing Address - Fax:
Practice Address - Street 1:132 FRANCISCO TER
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2615
Practice Address - Country:US
Practice Address - Phone:708-383-9259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001579363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care