Healthcare Provider Details

I. General information

NPI: 1073766267
Provider Name (Legal Business Name): CHRISTINE MAUREEN PALICKE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 W 203RD ST STE 203
OLYMPIA FIELDS IL
60461-1190
US

IV. Provider business mailing address

3800 W 203RD ST STE 203
OLYMPIA FIELDS IL
60461-1190
US

V. Phone/Fax

Practice location:
  • Phone: 708-747-4000
  • Fax: 708-503-3841
Mailing address:
  • Phone: 708-747-4000
  • Fax: 708-503-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number28106899A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209007612
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71002988A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: