Provider Demographics
NPI:1043758469
Name:NIKOLOVA, HRISTINA
Entity Type:Individual
Prefix:
First Name:HRISTINA
Middle Name:
Last Name:NIKOLOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8523 MCVICKER AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-2509
Mailing Address - Country:US
Mailing Address - Phone:773-817-8058
Mailing Address - Fax:
Practice Address - Street 1:8600 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60652-3633
Practice Address - Country:US
Practice Address - Phone:773-838-5681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide