Healthcare Provider Details

I. General information

NPI: 1770487464
Provider Name (Legal Business Name): JINI MATHAI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4885 HOFFMAN BLVD STE 100
HOFFMAN ESTATES IL
60192-3727
US

IV. Provider business mailing address

4885 HOFFMAN BLVD STE 100
HOFFMAN ESTATES IL
60192-3727
US

V. Phone/Fax

Practice location:
  • Phone: 847-645-1443
  • Fax: 708-202-5456
Mailing address:
  • Phone: 847-645-1443
  • Fax: 708-202-5456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number041278388
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: