Provider Demographics
NPI:1033555388
Name:FADIYA, VICTORIA O (DNP)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:O
Last Name:FADIYA
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
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Mailing Address - Street 1:9405 BORMET DR STE 10
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-7400
Mailing Address - Country:US
Mailing Address - Phone:708-481-0095
Mailing Address - Fax:866-299-8890
Practice Address - Street 1:9405 BORMET DR STE 10
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-7400
Practice Address - Country:US
Practice Address - Phone:708-481-0095
Practice Address - Fax:866-299-8890
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL277000226363LW0102X
IL209009857363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health