Healthcare Provider Details

I. General information

NPI: 1518609171
Provider Name (Legal Business Name): SANJINA SHRESTHA APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9977 WOODS DR STE 300
SKOKIE IL
60077-1057
US

IV. Provider business mailing address

9977 WOODS DR STE 300
SKOKIE IL
60077-1057
US

V. Phone/Fax

Practice location:
  • Phone: 847-663-8540
  • Fax: 847-663-1015
Mailing address:
  • Phone: 847-663-8540
  • Fax: 847-663-1015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209024305
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.024305
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: