Provider Demographics
NPI:1306313754
Name:NIEDZWIECKI, KLAUDIA DOROTA (NP-C)
Entity type:Individual
Prefix:
First Name:KLAUDIA
Middle Name:DOROTA
Last Name:NIEDZWIECKI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 W VETERANS PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-2510
Mailing Address - Country:US
Mailing Address - Phone:815-786-1088
Mailing Address - Fax:815-786-1314
Practice Address - Street 1:654 W VETERANS PKWY STE A
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-2510
Practice Address - Country:US
Practice Address - Phone:815-786-1088
Practice Address - Fax:815-786-1314
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.018321363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology