Provider Demographics
NPI:1700768769
Name:TKACZUK, BAYLEE ANNE (RN)
Entity type:Individual
Prefix:
First Name:BAYLEE
Middle Name:ANNE
Last Name:TKACZUK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25009 S SAGE ST
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-5037
Mailing Address - Country:US
Mailing Address - Phone:815-630-1028
Mailing Address - Fax:
Practice Address - Street 1:25009 S SAGE ST
Practice Address - Street 2:
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-5037
Practice Address - Country:US
Practice Address - Phone:815-630-1028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041564058163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse