Healthcare Provider Details

I. General information

NPI: 1255155628
Provider Name (Legal Business Name): DALYA OMAR DNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DALYA OMAR DALYA OMAR

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2553 W PETERSON AVE
CHICAGO IL
60659-4019
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 773-784-1025
  • Fax:
Mailing address:
  • Phone: 773-784-1025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.030855
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: