Healthcare Provider Details

I. General information

NPI: 1437794476
Provider Name (Legal Business Name): KHRYSTYNA HUZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 11/01/2025
Certification Date: 11/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 N CENTRAL AVE
CHICAGO IL
60630-3211
US

IV. Provider business mailing address

800 BROADVIEW VILLAGE SQ
BROADVIEW IL
60155-4887
US

V. Phone/Fax

Practice location:
  • Phone: 773-606-8092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.020356
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: