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General NPI Number Information
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NPI Number | 1548101843
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Entity Type | Individual
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Provider Name | KAITLYN DANIELLE VESEVICK AGPCNP-BC, DNP
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Gender | Female
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Dates
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Enumeration Date | 04/02/2026
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Last Update Date | 04/02/2026
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Provider Practice Location Address
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Address Line | 401 W LAKE ST
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City | NORTHLAKE
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State | IL
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Zip | 60164-2435
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Country | US
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Telephone | 630-640-9460
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Fax |
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Provider Business Mailing Address
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Address Line | 1150 N LAKE SHORE DR APT 16B
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City | CHICAGO
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State | IL
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Zip | 60611-5229
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Country | US
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Telephone | 630-640-9460
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 041497490
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License Number State | IL
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