Provider Demographics
NPI:1659035632
Name:FAYAZ, YASMIN (ARNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:YASMIN
Middle Name:
Last Name:FAYAZ
Suffix:
Gender:F
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W SUPERIOR ST APT 3310
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-8844
Mailing Address - Country:US
Mailing Address - Phone:786-338-0603
Mailing Address - Fax:
Practice Address - Street 1:2301 N CLARK ST STE 13
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3417
Practice Address - Country:US
Practice Address - Phone:844-787-4874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.024160363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care