Healthcare Provider Details

I. General information

NPI: 1821810540
Provider Name (Legal Business Name): ANURADHA TAMANG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W CERMAK RD # 3D
CHICAGO IL
60616-2268
US

IV. Provider business mailing address

7730 DEMPSTER ST UNIT 304
MORTON GROVE IL
60053-1877
US

V. Phone/Fax

Practice location:
  • Phone: 312-427-6000
  • Fax:
Mailing address:
  • Phone: 224-435-8510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209029635
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: