Provider Demographics
NPI:1740633510
Name:KOZLOWSKI, ANGELICA (APN)
Entity type:Individual
Prefix:MRS
First Name:ANGELICA
Middle Name:
Last Name:KOZLOWSKI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 PFINGSTEN RD.
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1057
Mailing Address - Country:US
Mailing Address - Phone:847-503-3000
Mailing Address - Fax:847-503-3500
Practice Address - Street 1:2180 PFINGSTEN RD.
Practice Address - Street 2:SUITE 3000
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1057
Practice Address - Country:US
Practice Address - Phone:847-503-3000
Practice Address - Fax:847-503-3500
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL20914474363LF0000X
IL209014474363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily