Provider Demographics
NPI:1518416791
Name:DAVE, PAHROUL (APN)
Entity Type:Individual
Prefix:
First Name:PAHROUL
Middle Name:
Last Name:DAVE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 STARFIRE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-1688
Mailing Address - Country:US
Mailing Address - Phone:815-434-2115
Mailing Address - Fax:
Practice Address - Street 1:1209 STARFIRE DR STE 1
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-1688
Practice Address - Country:US
Practice Address - Phone:815-434-2115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014880363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily