1013273374 NPI number — MRS. MARY PATRICIA KO APN NURSE PRACTITION

Table of content: MRS. MARY PATRICIA KO APN NURSE PRACTITION (NPI 1013273374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013273374 NPI number — MRS. MARY PATRICIA KO APN NURSE PRACTITION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KO
Provider First Name:
MARY
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APN NURSE PRACTITION
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRAUNSCHWEIG
Provider Other First Name:
MARY
Provider Other Middle Name:
PATRICIA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NURSE PRACTITIONER
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013273374
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1333 BURR RIDGE PKWY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
BURR RIDGE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-832-1775
Provider Business Mailing Address Fax Number:
630-832-3078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3800 N. CALIFORNIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-478-4222
Provider Business Practice Location Address Fax Number:
773-478-7867
Provider Enumeration Date:
04/11/2012

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: 363LA2100X , with the licence number:  AP60270270 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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