Healthcare Provider Details

I. General information

NPI: 1164946919
Provider Name (Legal Business Name): OLGA GILMAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 DEMPSTER ST
PARK RIDGE IL
60068-1186
US

IV. Provider business mailing address

3633 RUSSETT LN
NORTHBROOK IL
60062-4255
US

V. Phone/Fax

Practice location:
  • Phone: 847-897-9010
  • Fax:
Mailing address:
  • Phone: 847-312-3227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209.016228
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: