Healthcare Provider Details

I. General information

NPI: 1033615158
Provider Name (Legal Business Name): AYA DAJANI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 06/13/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 S. MARTIN LUTHER KING DR.
CHICAGO IL
60616
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 312-842-7117
  • Fax: 312-326-2102
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.017405
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: