Healthcare Provider Details

I. General information

NPI: 1871112755
Provider Name (Legal Business Name): FATIMA KHEMANI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 W JACKSON BLVD STE 310
CHICAGO IL
60612-3227
US

IV. Provider business mailing address

8745 N ORIOLE AVE
NILES IL
60714-2028
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-8120
  • Fax:
Mailing address:
  • Phone: 224-522-4359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number0414211546
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: