Provider Demographics
NPI:1598973042
Name:NIZNIK, CHARLOTTE MARY (APN)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:MARY
Last Name:NIZNIK
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1212 FAIR OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1236
Mailing Address - Country:US
Mailing Address - Phone:708-660-1516
Mailing Address - Fax:312-908-5564
Practice Address - Street 1:645 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2826
Practice Address - Country:US
Practice Address - Phone:312-503-4715
Practice Address - Fax:312-908-5564
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health