Healthcare Provider Details

I. General information

NPI: 1164281069
Provider Name (Legal Business Name): VIRPAL KAUR SIDHU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date: 04/09/2024
Reactivation Date: 06/04/2024

III. Provider practice location address

2300 N BARRINGTON RD STE 400
HOFFMAN ESTATES IL
60169-2036
US

IV. Provider business mailing address

2300 N BARRINGTON RD STE 400
HOFFMAN ESTATES IL
60169-2036
US

V. Phone/Fax

Practice location:
  • Phone: 815-947-4463
  • Fax:
Mailing address:
  • Phone: 815-947-4463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209030048
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: