Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 75TH ST
WILLOWBROOK IL
60527-2325
US

IV. Provider business mailing address

40 75TH ST
WILLOWBROOK IL
60527-2325
US

V. Phone/Fax

Practice location:
  • Phone: 630-581-5372
  • Fax: 630-568-3247
Mailing address:
  • Phone: 630-581-5372
  • Fax: 630-568-3247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: