Healthcare Provider Details

I. General information

NPI: 1992574032
Provider Name (Legal Business Name): GINA NICOLE SCHOLL-BOGAT APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2024
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 WEST AVE STE 100A
ORLAND PARK IL
60462-4600
US

IV. Provider business mailing address

15300 WEST AVE STE 100A
ORLAND PARK IL
60462-4600
US

V. Phone/Fax

Practice location:
  • Phone: 708-226-2318
  • Fax: 708-226-2319
Mailing address:
  • Phone: 708-226-2318
  • Fax: 708-226-2319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number041442610
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209029786
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209029786
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: