Provider Demographics
NPI:1356979629
Name:INCZAUKSKIS, KATHRYN MARGARET MARIE (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:MARGARET MARIE
Last Name:INCZAUKSKIS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:MARGARET MARIE
Other - Last Name:LAMBERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:375 N WALL ST
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3483
Mailing Address - Country:US
Mailing Address - Phone:815-933-2589
Mailing Address - Fax:815-634-5253
Practice Address - Street 1:400 S KENNEDY DR STE 700
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-2639
Practice Address - Country:US
Practice Address - Phone:815-935-7532
Practice Address - Fax:815-935-7495
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020930363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily