Provider Demographics
NPI:1285805655
Name:VITULSKI, MARGUERITE C (APN,FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MARGUERITE
Middle Name:C
Last Name:VITULSKI
Suffix:
Gender:F
Credentials:APN,FNP-C
Other - Prefix:MS
Other - First Name:MARGUERITE
Other - Middle Name:A
Other - Last Name:CLOHISY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN,FNP-C
Mailing Address - Street 1:2740 W FOSTER AVE
Mailing Address - Street 2:LL7
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3500
Mailing Address - Country:US
Mailing Address - Phone:773-878-8200
Mailing Address - Fax:773-293-4171
Practice Address - Street 1:2019 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3909
Practice Address - Country:US
Practice Address - Phone:773-293-8787
Practice Address - Fax:773-293-8793
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005047363LF0000X
IL209.005047363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR00730Medicare PIN
ILR00731Medicare PIN