1942332051 NPI number — MS. COLLEEN B BILECKI APRN, CNS

Table of content: MS. COLLEEN B BILECKI APRN, CNS (NPI 1942332051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942332051 NPI number — MS. COLLEEN B BILECKI APRN, CNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BILECKI
Provider First Name:
COLLEEN
Provider Middle Name:
B
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, CNS
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:
1942332051
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12251 S 80TH AVE STE 1520
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALOS HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60463-1290
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-923-4200
Provider Business Mailing Address Fax Number:
708-923-4201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12251 S 80TH AVE STE 1520
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALOS HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60463-1290
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-923-4200
Provider Business Practice Location Address Fax Number:
708-923-4201
Provider Enumeration Date:
03/12/2007

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: 364SA2200X , with the licence number:  209005969 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SM0705X , with the licence number: 209005969 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 209005969 , 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)