Healthcare Provider Details

I. General information

NPI: 1558196733
Provider Name (Legal Business Name): OLIVIA V NILSSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 W MADISON ST
CHICAGO IL
60624-2312
US

IV. Provider business mailing address

3800 W MADISON ST
CHICAGO IL
60624-2312
US

V. Phone/Fax

Practice location:
  • Phone: 773-826-6600
  • Fax:
Mailing address:
  • Phone: 773-826-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1168019
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: