Provider Demographics
NPI:1497067318
Name:HAJIAN, NISHA R (NP)
Entity Type:Individual
Prefix:
First Name:NISHA
Middle Name:R
Last Name:HAJIAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NISHA
Other - Middle Name:R
Other - Last Name:KUMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 850
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3124
Mailing Address - Country:US
Mailing Address - Phone:312-695-6180
Mailing Address - Fax:312-695-6189
Practice Address - Street 1:250 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2914
Practice Address - Country:US
Practice Address - Phone:312-695-6180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008134363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
F400374370Medicare PIN