Provider Demographics
NPI:1245887256
Name:NIEPSUJ, OLIVIA M (PA-C)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:M
Last Name:NIEPSUJ
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:800 N WESTMORELAND RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1671
Mailing Address - Country:US
Mailing Address - Phone:847-535-7657
Mailing Address - Fax:847-998-9303
Practice Address - Street 1:800 N WESTMORELAND RD STE 100
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1671
Practice Address - Country:US
Practice Address - Phone:847-535-7657
Practice Address - Fax:847-998-9303
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085007686363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant