Healthcare Provider Details

I. General information

NPI: 1871303024
Provider Name (Legal Business Name): OLIVIA GRACE DOCTER MSN, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST STE 14-200
CHICAGO IL
60611-5966
US

IV. Provider business mailing address

675 N SAINT CLAIR ST STE 14-200
CHICAGO IL
60611-5966
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-7382
  • Fax: 312-695-0014
Mailing address:
  • Phone: 312-695-7382
  • Fax: 312-695-0014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN.1001620-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209031847
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1681674
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.578655
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: