Healthcare Provider Details

I. General information

NPI: 1497697791
Provider Name (Legal Business Name): ASHA MATHEW APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1768 DOUGLAS RD STE 20
OSWEGO IL
60543-5112
US

IV. Provider business mailing address

1768 DOUGLAS RD STE 20
OSWEGO IL
60543-5112
US

V. Phone/Fax

Practice location:
  • Phone: 630-635-8288
  • Fax: 630-635-8347
Mailing address:
  • Phone: 630-635-8288
  • Fax: 630-635-8347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.035436
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: