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General NPI Number Information
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NPI Number | 1639430655
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Entity Type | Individual
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Provider Name | POOJA DAVE PATEL NP
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Gender | Female
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 12/26/2022
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Provider Practice Location Address
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Address Line | 1809 W CHICAGO AVE # 5
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City | CHICAGO
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State | IL
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Zip | 60622-5677
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Country | US
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Telephone | 630-709-7818
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Fax |
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Provider Business Mailing Address
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Address Line | 812 W VAN BUREN ST APT 4D
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City | CHICAGO
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State | IL
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Zip | 60607-3535
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Country | US
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Telephone | 630-709-7818
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209011185
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209011185
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License Number State | IL
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