Healthcare Provider Details

I. General information

NPI: 1881927457
Provider Name (Legal Business Name): MARIA NICOLE NILSSON M.S.N, A.P.N-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W 95TH ST STE 6409
OAK LAWN IL
60453-2654
US

IV. Provider business mailing address

4400 W 95TH ST SUITE 407-409
OAK LAWN IL
60453-2654
US

V. Phone/Fax

Practice location:
  • Phone: 877-684-4327
  • Fax: 708-684-7040
Mailing address:
  • Phone: 877-684-4327
  • Fax: 708-684-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number209.007591
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209-007591
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number209007591
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: