Healthcare Provider Details

I. General information

NPI: 1922823244
Provider Name (Legal Business Name): KIRSTIN OLHA MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6712 N CONVENT ST
BOURBONNAIS IL
60914-1528
US

IV. Provider business mailing address

900 RAND RD STE 300
DES PLAINES IL
60016-2359
US

V. Phone/Fax

Practice location:
  • Phone: 815-928-8050
  • Fax: 815-928-8932
Mailing address:
  • Phone: 847-324-3976
  • Fax: 847-929-1154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-031317
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: