Provider Demographics
NPI:1518516731
Name:EBOT, PATRICIA TAIWO ARREY (FNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:TAIWO ARREY
Last Name:EBOT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2036 W ARTHUR AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-5554
Mailing Address - Country:US
Mailing Address - Phone:773-671-8884
Mailing Address - Fax:
Practice Address - Street 1:2036 W ARTHUR AVE APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-5554
Practice Address - Country:US
Practice Address - Phone:773-671-8884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.019885363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty