Provider Demographics
NPI:1124582804
Name:PATEL, ASHA M (NP)
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:M
Last Name:PATEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ASHABEN
Other - Middle Name:B
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:427 COMMANCHE TRL
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-5118
Mailing Address - Country:US
Mailing Address - Phone:224-875-2710
Mailing Address - Fax:
Practice Address - Street 1:427 COMMANCHE TRL
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-5118
Practice Address - Country:US
Practice Address - Phone:224-875-2710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-26
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.18709363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily