Healthcare Provider Details

I. General information

NPI: 1427507433
Provider Name (Legal Business Name): KRYSTINA CHICKERILLO MSN,FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST 6TH FLOOR OPP
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

4440 W 95TH ST 6TH FLOOR OPP
OAK LAWN IL
60453-2600
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-7028
  • Fax:
Mailing address:
  • Phone: 708-684-7028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209015154
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041385803
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: