Healthcare Provider Details

I. General information

NPI: 1548101843
Provider Name (Legal Business Name): KAITLYN DANIELLE VESEVICK AGPCNP-BC, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 W BUTTERFIELD RD STE 325
ELMHURST IL
60126-5088
US

IV. Provider business mailing address

1150 N LAKE SHORE DR APT 16B
CHICAGO IL
60611-5229
US

V. Phone/Fax

Practice location:
  • Phone: 312-728-4728
  • Fax: 312-728-4729
Mailing address:
  • Phone: 630-640-9460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209034917
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041497490
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: