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General NPI Number Information
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NPI Number | 1285570028
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Entity Type | Organization
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Legal Business Name | VIVANT AESTHETICS AND WELLNESS
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Dates
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Enumeration Date | 04/24/2026
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Last Update Date | 04/24/2026
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Provider Practice Location Address
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Address Line | 127 N WALNUT ST STE 105
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City | ITASCA
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State | IL
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Zip | 60143-1768
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Country | US
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Telephone | 630-415-0550
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Fax |
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Provider Business Mailing Address
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Address Line | 127 N WALNUT ST STE 105
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City | ITASCA
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State | IL
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Zip | 60143-1768
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Country | US
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Telephone | 630-415-0550
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Fax |
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Authorized Official
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Title or Position | FULL PRACTICE AUTHORITY APRN
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Name | JESSICA SETLAK
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Credential | APRN
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Telephone | 630-415-0550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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