Individual ProviderKetina NiewiarowskiNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address77 Rand Rd, Des Plaines, IL 60016-1005(847) 298-0310(847) 390-5900PECOS EnrollmentBased on the most recent information from CMS, provider Ketina Niewiarowski is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1316306152Provider TypeIndividualFull NameNiewiarowski, KetinaCredentialFNPGenderFemaleSole ProprietorYesEnumeration Date2/22/2016Last Updated2/20/2023Contact InformationPractice LocationPractice Address77 Rand Rd, Des Plaines, IL 60016-1005Phone(847) 298-0310Fax(847) 298-5939Mailing LocationMailing Address29373 Network Pl, Chicago, IL 60673-1293Phone(847) 390-5900FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense209.013558Illinois