Provider Demographics
NPI:1215660469
Name:OMATTO, BRIANA (APRN)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:OMATTO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BRIANA
Other - Middle Name:
Other - Last Name:HOLUBIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1051 ESSINGTON ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-2812
Mailing Address - Country:US
Mailing Address - Phone:815-726-1818
Mailing Address - Fax:815-726-0232
Practice Address - Street 1:1051 ESSINGTON ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2812
Practice Address - Country:US
Practice Address - Phone:815-726-1818
Practice Address - Fax:815-726-0232
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041442575163W00000X
IL209025750363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse