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General NPI Number Information
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NPI Number | 1710879408
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Entity Type | Individual
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Provider Name | DR. MAMOONA B BAIG
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Gender | Female
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Dates
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Enumeration Date | 07/17/2025
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 1118 S LESLIE LN
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City | VILLA PARK
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State | IL
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Zip | 60181-3131
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Country | US
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Telephone | 224-508-8413
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Fax |
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Provider Business Mailing Address
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Address Line | 1118 S LESLIE LN
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City | VILLA PARK
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State | IL
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Zip | 60181-3131
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Country | US
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Telephone | 224-508-8413
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 209.032806
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 041.422110
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License Number State | IL
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