Healthcare Provider Details

I. General information

NPI: 1366892218
Provider Name (Legal Business Name): ALAMMA G ARACKAL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 SHEPHERD DR
DES PLAINES IL
60018-2029
US

IV. Provider business mailing address

1921 SHEPHERD DR
DES PLAINES IL
60018-2029
US

V. Phone/Fax

Practice location:
  • Phone: 847-699-8642
  • Fax:
Mailing address:
  • Phone: 847-699-8642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number041264588
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209014315
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: