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General NPI Number Information
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NPI Number | 1285282210
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Entity Type | Individual
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Provider Name | HIMJA BHATT
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Gender | Female
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Dates
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Enumeration Date | 09/03/2019
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Last Update Date | 09/03/2019
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Provider Practice Location Address
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Address Line | 2202 ESSINGTON RD STE 101
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City | JOLIET
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State | IL
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Zip | 60435-1604
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Country | US
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Telephone | 815-676-5310
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Fax |
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Provider Business Mailing Address
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Address Line | 5705 HOLMES AVE APT 1C
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City | CLARENDON HILLS
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State | IL
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Zip | 60514-1685
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Country | US
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Telephone | 630-484-1908
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.019956
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License Number State | IL
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