Healthcare Provider Details

I. General information

NPI: 1598438228
Provider Name (Legal Business Name): NIKETA ANKUR PATEL NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30W001 DEAN CT
WAYNE IL
60184-2499
US

IV. Provider business mailing address

30W001 DEAN CT
WAYNE IL
60184-2499
US

V. Phone/Fax

Practice location:
  • Phone: 630-272-6128
  • Fax:
Mailing address:
  • Phone: 630-272-6128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number209.022336
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209022336
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: