Healthcare Provider Details

I. General information

NPI: 1144134487
Provider Name (Legal Business Name): VICTORIA TABATCHOUK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E SOUTH WATER ST APT 2303
CHICAGO IL
60601-4134
US

IV. Provider business mailing address

360 E SOUTH WATER ST APT 2303
CHICAGO IL
60601-4134
US

V. Phone/Fax

Practice location:
  • Phone: 773-912-3009
  • Fax:
Mailing address:
  • Phone: 773-912-3009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209036557
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: