Healthcare Provider Details

I. General information

NPI: 1770495012
Provider Name (Legal Business Name): ASHA SANJU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1N165 PAPWORTH ST
CAROL STREAM IL
60188-2318
US

IV. Provider business mailing address

1N165 PAPWORTH ST
CAROL STREAM IL
60188-2318
US

V. Phone/Fax

Practice location:
  • Phone: 630-785-8947
  • Fax:
Mailing address:
  • Phone: 630-785-8947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number041431189
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: