Healthcare Provider Details

I. General information

NPI: 1790467769
Provider Name (Legal Business Name): TALIA COVELESKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2753 N HAMPDEN CT APT 2C
CHICAGO IL
60614-2331
US

IV. Provider business mailing address

2753 N HAMPDEN CT APT 2C
CHICAGO IL
60614-2331
US

V. Phone/Fax

Practice location:
  • Phone: 814-520-4870
  • Fax:
Mailing address:
  • Phone: 814-520-4870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number041529764
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: