MEDICARE: MOHINI GHAYAL FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	209.021429	IL
2	363LF0000X	Family Nurse Practitioner	209.021429	IL

General Provider Information

NPI Number	:	1093315186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHINI GHAYAL FNP

Provider Business Mailing Address
First Line	:	4613 KINGS WALK DR APT 1B
Second Line	:
City	:	ROLLING MEADOWS
State	:	IL
Zip	:	60008-1949
Country	:	US
Telephone Number	:	224-558-4213
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 W KENSINGTON RD STE 102
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-1141
Country	:	US
Telephone Number	:	847-222-9060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2020
Last Update Date	:	10/28/2020

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