Healthcare Provider Details

I. General information

NPI: 1437780541
Provider Name (Legal Business Name): NIKITA PATEL APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 WEAVER PKWY
WARRENVILLE IL
60555-3269
US

IV. Provider business mailing address

4405 WEAVER PKWY
WARRENVILLE IL
60555-3269
US

V. Phone/Fax

Practice location:
  • Phone: 630-352-5450
  • Fax: 630-938-8849
Mailing address:
  • Phone: 630-352-5450
  • Fax: 630-938-8849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.020762
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.020762
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: