Provider Demographics
NPI:1053092841
Name:KOZHEVNIKOVA, GALINA (APRN, CNP)
Entity type:Individual
Prefix:MRS
First Name:GALINA
Middle Name:
Last Name:KOZHEVNIKOVA
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1521
Mailing Address - Country:US
Mailing Address - Phone:847-475-2273
Mailing Address - Fax:847-535-7761
Practice Address - Street 1:870 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1521
Practice Address - Country:US
Practice Address - Phone:847-475-2273
Practice Address - Fax:847-535-7761
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209027643363L00000X
IL2022153126363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner