MEDICARE: MS. NATALIYA OMELCHENKO APN-CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	041338184	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	216958	OTHER	IL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041338184	OTHER	IL	STATE LICENSE

General Provider Information

NPI Number	:	1558548099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NATALIYA OMELCHENKO APN-CNP

Provider Business Mailing Address
First Line	:	PO BOX 2074
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-6074
Country	:	US
Telephone Number	:	773-412-6489
Fax Number	:	224-676-1038

Provider Business Practice Location Address
First Line	:	880 W CENTRAL RD STE 4100
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-2383
Country	:	US
Telephone Number	:	847-618-5879
Fax Number	:	847-618-4409

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	05/10/2021

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