Healthcare Provider Details

I. General information

NPI: 1568771723
Provider Name (Legal Business Name): INGRID TATHAM R.N, APN, NPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 E PALATINE RD
PALATINE IL
60074-5551
US

IV. Provider business mailing address

909 E PALATINE RD
PALATINE IL
60074-5551
US

V. Phone/Fax

Practice location:
  • Phone: 847-776-1400
  • Fax: 847-776-1424
Mailing address:
  • Phone: 847-776-1400
  • Fax: 847-776-1424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209008259
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: