Skyrose Rejuvenation Clinic & Spa LLC
Nurse Practitioner, Family in Orland Park, IL. Organization (NPI-2).
NPI number1033736210
StatusActive
Last updated in NPPESMar 29, 2022
Details
- NPI
- 1033736210
- Entity type
- Organization (NPI-2)
- Legal business name
- Skyrose Rejuvenation Clinic & Spa LLC
- Organization subpart
- No
- Enumeration date
- Jul 3, 2020
- Certification date
- Mar 29, 2022
- Last updated
- Mar 29, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | – | – | Yes |
Other names
- Healthcare, Esthetic Procedures (Other Name)
Practice location
9021 W 151st StOrland Park, IL 60462-3201
Phone 708-966-4258
Mailing address
22544 Crescent WayRichton Park, IL 60471-1861
Phone 773-558-9597
Authorized official
Chakika L Williams
Nurse Practitioner/Owner
7735589597
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