Provider Demographics
NPI:1780955203
Name:KROLAK, ELIZABETH SARAH (PNP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:SARAH
Last Name:KROLAK
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 W BERENICE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2722
Mailing Address - Country:US
Mailing Address - Phone:773-339-9065
Mailing Address - Fax:
Practice Address - Street 1:680 N LAKE SHORE DR STE 1050
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3054
Practice Address - Country:US
Practice Address - Phone:312-642-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.005372363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics