Provider Demographics
NPI:1861514408
Name:BLACHOWICZ, EWA (NP,APN)
Entity type:Individual
Prefix:
First Name:EWA
Middle Name:
Last Name:BLACHOWICZ
Suffix:
Gender:F
Credentials:NP,APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16632 S 107TH CT
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467
Mailing Address - Country:US
Mailing Address - Phone:708-349-6350
Mailing Address - Fax:708-349-9153
Practice Address - Street 1:16632 S 107TH CT
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467
Practice Address - Country:US
Practice Address - Phone:708-349-6350
Practice Address - Fax:708-349-9153
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006532363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209006532OtherSTATE LICENSE NUMBER
P00440573OtherMEDICARE RAILROAD
K36504Medicare PIN