Provider Demographics
NPI:1487340949
Name:VIRT, SVETLANA (RN, BSN)
Entity type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:VIRT
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 MUNICIPAL DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-5483
Mailing Address - Country:US
Mailing Address - Phone:815-759-2306
Mailing Address - Fax:815-759-1953
Practice Address - Street 1:3715 MUNICIPAL DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5483
Practice Address - Country:US
Practice Address - Phone:815-759-2306
Practice Address - Fax:815-759-1953
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041394711163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management