Basic Information
| Provider Information | |||||||||
| NPI: | 1245887256 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIEPSUJ | ||||||||
| FirstName: | OLIVIA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 N WESTMORELAND RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | LAKE FOREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600451671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475357657 | ||||||||
| FaxNumber: | 8479989303 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 N WESTMORELAND RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | LAKE FOREST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600451671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475357657 | ||||||||
| FaxNumber: | 8479989303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2019 | ||||||||
| LastUpdateDate: | 05/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 085007686 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.