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General NPI Number Information
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NPI Number | 1871303024
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Entity Type | Individual
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Provider Name | OLIVIA GRACE DOCTER MSN, WHNP
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Gender | Female
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 675 N SAINT CLAIR ST STE 14-200
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City | CHICAGO
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State | IL
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Zip | 60611-5966
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Country | US
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Telephone | 312-695-7382
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Fax | 312-695-0014
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Provider Business Mailing Address
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Address Line | 675 N SAINT CLAIR ST STE 14-200
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City | CHICAGO
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State | IL
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Zip | 60611-5966
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Country | US
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Telephone | 312-695-7382
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Fax | 312-695-0014
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209031847
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN.1681674
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041.578655
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License Number State | IL
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