Provider Demographics
NPI:1902439193
Name:BOSKA, IWONA (APRN)
Entity Type:Individual
Prefix:
First Name:IWONA
Middle Name:
Last Name:BOSKA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 2140
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3143
Mailing Address - Country:US
Mailing Address - Phone:312-695-0990
Mailing Address - Fax:312-664-5854
Practice Address - Street 1:676 N ST.CLAIR STREET
Practice Address - Street 2:SUITE 2140
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-695-6832
Practice Address - Fax:312-695-7814
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.020836363LA2200X
IL209020836363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health