Provider Demographics
NPI:1255001384
Name:NANTAMBI, SAUDAH
Entity Type:Individual
Prefix:
First Name:SAUDAH
Middle Name:
Last Name:NANTAMBI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WALDEN TRL
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-1680
Mailing Address - Country:US
Mailing Address - Phone:224-428-4047
Mailing Address - Fax:
Practice Address - Street 1:310 ARIZONA BLVD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1923
Practice Address - Country:US
Practice Address - Phone:224-595-9890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043.130429164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL53578090894NOtherSTATE OF ILLINOIS