Provider Demographics
NPI:1912473588
Name:CIESLAK, STEPHANIA ANNA (RN)
Entity Type:Individual
Prefix:
First Name:STEPHANIA
Middle Name:ANNA
Last Name:CIESLAK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 W 105TH ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4365
Mailing Address - Country:US
Mailing Address - Phone:708-516-7287
Mailing Address - Fax:
Practice Address - Street 1:5800 W 105TH ST APT 3A
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4365
Practice Address - Country:US
Practice Address - Phone:708-516-7287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.470266163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse