Provider Demographics
NPI:1598438228
Name:PATEL, NIKETA ANKUR (NP-C)
Entity Type:Individual
Prefix:
First Name:NIKETA
Middle Name:ANKUR
Last Name:PATEL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30W001 DEAN CT
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:IL
Mailing Address - Zip Code:60184-2499
Mailing Address - Country:US
Mailing Address - Phone:630-272-6128
Mailing Address - Fax:
Practice Address - Street 1:30W001 DEAN CT
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:IL
Practice Address - Zip Code:60184-2499
Practice Address - Country:US
Practice Address - Phone:630-272-6128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.022336207Q00000X
IL209022336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty