1013014307 NPI number — MS. RENE MARIE STOLARCZYK RN, NP

Table of content: MS. RENE MARIE STOLARCZYK RN, NP (NPI 1013014307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013014307 NPI number — MS. RENE MARIE STOLARCZYK RN, NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOLARCZYK
Provider First Name:
RENE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN, NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013014307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HINES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-202-3512
Provider Business Mailing Address Fax Number:
708-202-4700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5TH AVENUE
Provider Second Line Business Practice Location Address:
BUILDING 228
Provider Business Practice Location Address City Name:
HINES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-202-3512
Provider Business Practice Location Address Fax Number:
708-202-4700
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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