Basic Information
| Provider Information | |||||||||
| NPI: | 1477188449 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAWICKI | ||||||||
| FirstName: | DALIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4440 WEST 95TH STREET | ||||||||
| Address2: | ASHU | ||||||||
| City: | OAK LAWN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086848000 | ||||||||
| FaxNumber: | 7086841987 | ||||||||
| Practice Location | |||||||||
| Address1: | 4440 WEST 95TH STREET | ||||||||
| Address2: | ASHU | ||||||||
| City: | OAK LAWN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086848000 | ||||||||
| FaxNumber: | 7086841987 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2020 | ||||||||
| LastUpdateDate: | 09/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 209021095 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 05 | IL | MEDICAID |