Provider Demographics
NPI:1235924150
Name:IZEWSKI, RENATA (LAC BS NUTR)
Entity type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:IZEWSKI
Suffix:
Gender:
Credentials:LAC BS NUTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1094 S ROSELLE RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-3961
Mailing Address - Country:US
Mailing Address - Phone:847-301-1377
Mailing Address - Fax:847-301-1378
Practice Address - Street 1:1094 S ROSELLE RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-3961
Practice Address - Country:US
Practice Address - Phone:847-301-1377
Practice Address - Fax:847-301-1378
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.001655171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty