Healthcare Provider Details

I. General information

NPI: 1124443031
Provider Name (Legal Business Name): TANYA TREASA CHIRAYIL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TANYA TREASA UTHUP

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 GROSS POINT RD STE 3900
SKOKIE IL
60076-5085
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2570
  • Fax: 847-933-3520
Mailing address:
  • Phone: 847-982-6715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209011189
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209011189041355741
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: