Healthcare Provider Details

I. General information

NPI: 1699173856
Provider Name (Legal Business Name): OLIVIA NICOLE CORRADO APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2014
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ERIE CT STE 7120
OAK PARK IL
60302-2510
US

IV. Provider business mailing address

1 ERIE CT STE 7120
OAK PARK IL
60302-2510
US

V. Phone/Fax

Practice location:
  • Phone: 773-573-0020
  • Fax: 773-537-0029
Mailing address:
  • Phone: 773-573-0020
  • Fax: 773-573-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP60515110
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209022755
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209022755
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: