MEDICARE: MS. YELENA D NIKITINA CASE MANAGER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	2002-0077	IL

General Provider Information

NPI Number	:	1073788006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YELENA D NIKITINA CASE MANAGER

Provider Business Mailing Address
First Line	:	1607 W HOWARD ST
Second Line	:	3FL
City	:	CHICAGO
State	:	IL
Zip	:	60626-1675
Country	:	US
Telephone Number	:	312-744-7617
Fax Number	:	312-744-1621

Provider Business Practice Location Address
First Line	:	1607 W HOWARD ST
Second Line	:	3FL
City	:	CHICAGO
State	:	IL
Zip	:	60626-1675
Country	:	US
Telephone Number	:	312-744-7617
Fax Number	:	312-744-1621

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	04/30/2008

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