Healthcare Provider Details

I. General information

NPI: 1043172158
Provider Name (Legal Business Name): VITALIYA KHOLODYNSKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 BEDFORD CT
HAWTHORN WOODS IL
60047-1621
US

IV. Provider business mailing address

8 BEDFORD CT
HAWTHORN WOODS IL
60047-1621
US

V. Phone/Fax

Practice location:
  • Phone: 773-396-0291
  • Fax: 773-396-0291
Mailing address:
  • Phone: 773-396-0291
  • Fax: 773-396-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209033818
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: