Healthcare Provider Details

I. General information

NPI: 1194595132
Provider Name (Legal Business Name): MANALI NAIK APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 N FARNSWORTH AVE
AURORA IL
60505-3004
US

IV. Provider business mailing address

2406 SUNSHINE LN
AURORA IL
60503-6750
US

V. Phone/Fax

Practice location:
  • Phone: 630-898-0022
  • Fax:
Mailing address:
  • Phone: 630-809-4517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209028631
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: