Provider Demographics
NPI:1558548099
Name:OMELCHENKO, NATALIYA (APN-CNP)
Entity Type:Individual
Prefix:MS
First Name:NATALIYA
Middle Name:
Last Name:OMELCHENKO
Suffix:
Gender:F
Credentials:APN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2074
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-6074
Mailing Address - Country:US
Mailing Address - Phone:773-412-6489
Mailing Address - Fax:224-676-1038
Practice Address - Street 1:880 W CENTRAL RD STE 4100
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2383
Practice Address - Country:US
Practice Address - Phone:847-618-5879
Practice Address - Fax:847-618-4409
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041338184363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041338184OtherSTATE LICENSE
IL216958OtherMEDICARE PTAN