Provider Demographics
NPI:1427571710
Name:MATHEW, PRIYA SANIL (APN)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:SANIL
Last Name:MATHEW
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:PRIYA
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:151 LOS LAGOS DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-3047
Mailing Address - Country:US
Mailing Address - Phone:630-881-1303
Mailing Address - Fax:
Practice Address - Street 1:151 LOS LAGOS DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108
Practice Address - Country:US
Practice Address - Phone:630-881-1303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016184363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily