=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679043541
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCE PRACTITIONERS IN HEALTH,INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2018
-----------------------------------------------------
Last Update Date | 12/04/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 INGLEWOOD LN
-----------------------------------------------------
City | ELGIN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60120-4942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-398-1935
-----------------------------------------------------
Fax | 630-282-7468
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 INGLEWOOD LN
-----------------------------------------------------
City | ELGIN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60120-4942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-398-1935
-----------------------------------------------------
Fax | 630-282-7468
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. REGINA MARIE MAHMOOD
-----------------------------------------------------
Credential | NP-C
-----------------------------------------------------
Telephone | 630-398-1935
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------