Provider Demographics
NPI:1619732781
Name:VALAITIS, KAROLINA (NP)
Entity type:Individual
Prefix:
First Name:KAROLINA
Middle Name:
Last Name:VALAITIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 LONG COVE DR
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-7730
Mailing Address - Country:US
Mailing Address - Phone:708-566-7515
Mailing Address - Fax:
Practice Address - Street 1:1S376 SUMMIT AVE STE 2C
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3961
Practice Address - Country:US
Practice Address - Phone:708-307-3655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015267363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner