Provider Demographics
NPI:1083248660
Name:KOMAROVA, NADEZHDA O (APN)
Entity Type:Individual
Prefix:
First Name:NADEZHDA
Middle Name:O
Last Name:KOMAROVA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6071 MILL BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-2864
Mailing Address - Country:US
Mailing Address - Phone:312-532-5629
Mailing Address - Fax:
Practice Address - Street 1:6071 MILL BRIDGE LN
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-2864
Practice Address - Country:US
Practice Address - Phone:312-532-5629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277.002695363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily