Provider Demographics
NPI:1457183659
Name:WOJCIK, KELLEY (WHNP-BC)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:WOJCIK
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:SHERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:430 WARRENVILLE RD STE 310
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1348
Practice Address - Country:US
Practice Address - Phone:630-893-8585
Practice Address - Fax:630-690-4810
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.029958363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner