Healthcare Provider Details

I. General information

NPI: 1124607056
Provider Name (Legal Business Name): PRACHI PATEL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 LINCOLN HWY
MOKENA IL
60448-8208
US

IV. Provider business mailing address

110 W NORTH AVE
ELMHURST IL
60126-2736
US

V. Phone/Fax

Practice location:
  • Phone: 877-993-4321
  • Fax:
Mailing address:
  • Phone: 186-638-9272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.022883
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.022883
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: