Healthcare Provider Details

I. General information

NPI: 1285976936
Provider Name (Legal Business Name): CAROLINE MICHELE ONISCHAK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 GRANDSTAND PL
ELGIN IL
60123-4983
US

IV. Provider business mailing address

1845 GRANDSTAND PL
ELGIN IL
60123-4983
US

V. Phone/Fax

Practice location:
  • Phone: 847-695-0484
  • Fax: 847-695-1436
Mailing address:
  • Phone: 847-695-0484
  • Fax: 847-695-1436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209020867
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number041.408853
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: