Individual
BRIANNA WICINSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1117 S MILWAUKEE AVE STE B14, LIBERTYVILLE, IL 60048-5258
(224) 234-9299
Mailing address
1117 S MILWAUKEE AVE STE B14, LIBERTYVILLE, IL 60048-5258
(224) 234-9299
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209-019990
IL
363L00000X
Nurse Practitioner
Primary
277.001625
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209019990
NP LICENSE
IL
Enumeration date
09/09/2019
Last updated
08/04/2024
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