Individual
PAMELA KOMANIECKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, PMHNP-BC
Contact information
Practice address
12 HEALTH SERVICES DR, DEKALB, IL 60115-9637
(815) 756-4875
(815) 756-2944
Mailing address
PO BOX 1109, DEKALB, IL 60115-7109
(815) 756-4875
(815) 756-2944
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
049.1467133
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209.030218
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
474579189001
—
IL
Enumeration date
12/14/2022
Last updated
09/13/2024
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