Healthcare Provider Details

I. General information

NPI: 1003493958
Provider Name (Legal Business Name): TRACY O OMOROGIEVA APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18W140 BUTTERFIELD RD FL 15
OAKBROOK TERRACE IL
60181-4843
US

IV. Provider business mailing address

2650 RIDGE AVE # 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 773-276-2655
  • Fax: 773-639-2346
Mailing address:
  • Phone: 847-982-3175
  • Fax: 847-982-3394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.022270
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: