Healthcare Provider Details

I. General information

NPI: 1851232839
Provider Name (Legal Business Name): POOMANI GOVENDER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 W HARRISON STREET, POB 970
CHICAGO IL
60612
US

IV. Provider business mailing address

1620 W HARRISON STREET, POB 970
CHICAGO IL
60612-3801
US

V. Phone/Fax

Practice location:
  • Phone: 312-563-3447
  • Fax:
Mailing address:
  • Phone: 312-563-3447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.034439
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209.034439
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.445663
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number041.445663
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: