Provider Demographics
NPI:1194190975
Name:YOHALEM, OLGA V (NP)
Entity Type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:V
Last Name:YOHALEM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:PELYH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:760 BUSSE HWY
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-2402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9150 GRANFORD AVE L & Y GROUP S.C.
Practice Address - Street 2:SUITE 107
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1769
Practice Address - Country:US
Practice Address - Phone:847-329-7799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-05
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.012431363L00000X
IL209012431363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL349981169001Medicaid