Provider Demographics
NPI:1093301541
Name:VITEK, ALICIA (NP-C)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:VITEK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 S RIVER RD
Mailing Address - Street 2:STE 130
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-4110
Mailing Address - Country:US
Mailing Address - Phone:630-880-1682
Mailing Address - Fax:
Practice Address - Street 1:2010 S ARLINGTON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4134
Practice Address - Country:US
Practice Address - Phone:847-258-4978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022407363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty