Provider Demographics
NPI:1114570355
Name:TANVIR, NIMRA (PA-C)
Entity Type:Individual
Prefix:
First Name:NIMRA
Middle Name:
Last Name:TANVIR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 N HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-4305
Mailing Address - Country:US
Mailing Address - Phone:773-237-6666
Mailing Address - Fax:773-237-7350
Practice Address - Street 1:1733 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-4305
Practice Address - Country:US
Practice Address - Phone:773-237-6666
Practice Address - Fax:773-237-7350
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.007101363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant