Provider Demographics
NPI:1568228278
Name:PATEL, KRISHNA VIVAN
Entity Type:Individual
Prefix:
First Name:KRISHNA
Middle Name:VIVAN
Last Name:PATEL
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 1:13028 CATHY LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-6944
Mailing Address - Country:US
Mailing Address - Phone:630-597-5709
Mailing Address - Fax:
Practice Address - Street 1:13028 CATHY LN
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-6944
Practice Address - Country:US
Practice Address - Phone:630-597-5709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.452413163W00000X
IL209.027437363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse