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General NPI Number Information
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NPI Number | 1578385571
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Entity Type | Individual
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Provider Name | AMRITA KAUR RANDHAWA AGACNP
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Gender | Female
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 1725 W HARRISON ST STE 1106
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City | CHICAGO
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State | IL
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Zip | 60612-3845
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Country | US
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Telephone | 312-942-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 4718 WINDRIDGE CT
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City | CARPENTERSVILLE
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State | IL
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Zip | 60110-3442
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Country | US
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Telephone | 847-910-3207
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 209030998
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License Number State | IL
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