Healthcare Provider Details

I. General information

NPI: 1992642292
Provider Name (Legal Business Name): ENIJA SHRESTHA SHIWAKOTI MPH,FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 S RIVER RD
DES PLAINES IL
60018-2206
US

IV. Provider business mailing address

1920 SEQUOIA DR
HANOVER PARK IL
60133-3981
US

V. Phone/Fax

Practice location:
  • Phone: 224-803-2274
  • Fax:
Mailing address:
  • Phone: 701-730-8228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209035225
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: