Healthcare Provider Details

I. General information

NPI: 1518854710
Provider Name (Legal Business Name): NESREEN RAHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 E OGDEN AVE STOP 109
NAPERVILLE IL
60563-1631
US

IV. Provider business mailing address

1355 E OGDEN AVE STOP 109
NAPERVILLE IL
60563-1631
US

V. Phone/Fax

Practice location:
  • Phone: 630-984-9480
  • Fax:
Mailing address:
  • Phone: 630-984-9480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085011268
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: