Healthcare Provider Details

I. General information

NPI: 1285075697
Provider Name (Legal Business Name): YAFFA Y KAGAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YAFFA Y SABGHIR NP

II. Dates (important events)

Enumeration Date: 07/13/2013
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE
EVANSTON IL
60201-1700
US

IV. Provider business mailing address

2650 RIDGE AVE
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 475-702-3048
  • Fax: 847-733-5247
Mailing address:
  • Phone: 475-702-3048
  • Fax: 847-733-5247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number630717
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401647
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number309.013317
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: