Provider Demographics
NPI:1659047579
Name:NINAN, PRINCY (FNP)
Entity Type:Individual
Prefix:
First Name:PRINCY
Middle Name:
Last Name:NINAN
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 1:183 N EAST RIVER RD UNIT D6
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1286
Mailing Address - Country:US
Mailing Address - Phone:847-863-8323
Mailing Address - Fax:
Practice Address - Street 1:183 N EAST RIVER RD UNIT D6
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1286
Practice Address - Country:US
Practice Address - Phone:847-863-8323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily