Individual
MRS. AGNIESZKA STANISLAWA BASTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
1201 EAGLE STREET, JOLIET, IL 60432
(815) 740-8100
Mailing address
24522 NORTH KELSEY ROAD, LAKE BARRINGTON, IL 60010
(847) 224-4576
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209016452
IL
Other
Enumeration date
09/23/2017
Last updated
09/23/2017
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