Healthcare Provider Details

I. General information

NPI: 1558819664
Provider Name (Legal Business Name): YULIYA IHLITSKAYA PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2016
Last Update Date: 09/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W IRVING PARK RD
CHICAGO IL
60613-3077
US

IV. Provider business mailing address

850 W IRVING PARK RD
CHICAGO IL
60613-3077
US

V. Phone/Fax

Practice location:
  • Phone: 773-975-6775
  • Fax: 312-228-1409
Mailing address:
  • Phone: 773-975-6775
  • Fax: 312-228-1409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.014794
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: