Healthcare Provider Details

I. General information

NPI: 1386462794
Provider Name (Legal Business Name): DHARA PATEL APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 S GARY AVE
BLOOMINGDALE IL
60108-2213
US

IV. Provider business mailing address

233 S GARY AVE
BLOOMINGDALE IL
60108-2213
US

V. Phone/Fax

Practice location:
  • Phone: 331-732-6070
  • Fax: 331-732-6075
Mailing address:
  • Phone: 331-732-6070
  • Fax: 331-732-6075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209030285
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.030285
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: