Healthcare Provider Details

I. General information

NPI: 1750777595
Provider Name (Legal Business Name): MUCHAFARA TARIRO MANIKI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 SUMMIT ST
ELGIN IL
60120-3843
US

IV. Provider business mailing address

1816 LINTON CT APT 201
SCHAUMBURG IL
60193-5067
US

V. Phone/Fax

Practice location:
  • Phone: 847-608-1344
  • Fax:
Mailing address:
  • Phone: 317-332-0530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209013121
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041429144
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: