Provider Demographics
NPI:1457694101
Name:JANICEK, M. PATRICIA (RN, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:M. PATRICIA
Middle Name:
Last Name:JANICEK
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6103 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-2003
Mailing Address - Country:US
Mailing Address - Phone:630-776-6975
Mailing Address - Fax:
Practice Address - Street 1:545 PLAINFIELD RD STE C
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-7601
Practice Address - Country:US
Practice Address - Phone:630-654-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041196581163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant