Provider Demographics
NPI:1669565800
Name:DAY, VICKI
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:DAY
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 1:416 E LOCUST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60921
Mailing Address - Country:US
Mailing Address - Phone:815-635-3177
Mailing Address - Fax:815-635-3008
Practice Address - Street 1:416 E LOCUST
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:IL
Practice Address - Zip Code:60921
Practice Address - Country:US
Practice Address - Phone:815-635-3177
Practice Address - Fax:815-635-3008
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041156110/209002748363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK00562Medicare ID - Type UnspecifiedINDIVIDUAL #
IL23950Medicare ID - Type UnspecifiedPONTIAC INDIVIDUAL #
S38168Medicare UPIN
IL207991Medicare ID - Type UnspecifiedGROUP #
ILCA2182Medicare ID - Type UnspecifiedRR GROUP #