Provider Demographics
NPI:1760953889
Name:GANDHI, URVI A (FNP-BC)
Entity Type:Individual
Prefix:
First Name:URVI
Middle Name:A
Last Name:GANDHI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10116 MANSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4303
Mailing Address - Country:US
Mailing Address - Phone:708-785-7929
Mailing Address - Fax:
Practice Address - Street 1:2307 S CICERO AVE STE 9
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2451
Practice Address - Country:US
Practice Address - Phone:708-780-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018532363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily