Healthcare Provider Details

I. General information

NPI: 1841124351
Provider Name (Legal Business Name): JULIA PETERSON DNP, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

200 N ARLINGTON HEIGHTS RD APT 212
ARLINGTON HEIGHTS IL
60004-6046
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-8000
  • Fax:
Mailing address:
  • Phone: 331-425-4251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number209.035502
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: