MEDICARE: TALIA COVELESKI RN

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	163WC1500X	Community Health Registered Nurse	041529764	IL

General Provider Information

NPI Number	:	1790467769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TALIA COVELESKI RN

Provider Business Mailing Address
First Line	:	2753 N HAMPDEN CT APT 2C
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2331
Country	:	US
Telephone Number	:	814-520-4870
Fax Number	:

Provider Business Practice Location Address
First Line	:	2753 N HAMPDEN CT APT 2C
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2331
Country	:	US
Telephone Number	:	814-520-4870
Fax Number	:

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

Provider Enumeration Date	:	08/01/2023
Last Update Date	:	08/01/2023

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