Healthcare Provider Details

I. General information

NPI: 1053092841
Provider Name (Legal Business Name): GALINA KOZHEVNIKOVA APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 N MILWAUKEE AVE
VERNON HILLS IL
60061-1521
US

IV. Provider business mailing address

870 N MILWAUKEE AVE
VERNON HILLS IL
60061-1521
US

V. Phone/Fax

Practice location:
  • Phone: 847-475-2273
  • Fax: 847-535-7761
Mailing address:
  • Phone: 847-475-2273
  • Fax: 847-535-7761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209027643
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2022153126
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: