Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | IL |
NPI | 1013014307 |
---|---|
Provider Name | Ms. Rene Marie Stolarczyk |
First Address | Hines, IL 60141 |
Second Address | Hines, IL 60141 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |