Provider Demographics
NPI:1669770129
Name:BUKIEWICZ, ANDREA L (CPM, LM)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:BUKIEWICZ
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2341
Mailing Address - Country:US
Mailing Address - Phone:773-964-6096
Mailing Address - Fax:
Practice Address - Street 1:302 PARK AVE
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2341
Practice Address - Country:US
Practice Address - Phone:773-964-6096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI119-49176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife