Healthcare Provider Details

I. General information

NPI: 1285570028
Provider Name (Legal Business Name): VIVANT AESTHETICS AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 N WALNUT ST STE 105
ITASCA IL
60143-1768
US

IV. Provider business mailing address

127 N WALNUT ST STE 105
ITASCA IL
60143-1768
US

V. Phone/Fax

Practice location:
  • Phone: 630-415-0550
  • Fax:
Mailing address:
  • Phone: 630-415-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JESSICA SETLAK
Title or Position: FULL PRACTICE AUTHORITY APRN
Credential: APRN
Phone: 630-415-0550