Provider Demographics
NPI:1780012351
Name:ARACKAL, ELSAMMA (APN/CNP)
Entity Type:Individual
Prefix:
First Name:ELSAMMA
Middle Name:
Last Name:ARACKAL
Suffix:
Gender:F
Credentials:APN/CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 MARINA DR
Mailing Address - Street 2:APT/SUITE
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2241
Mailing Address - Country:US
Mailing Address - Phone:224-210-0005
Mailing Address - Fax:847-296-6916
Practice Address - Street 1:165 MARINA DR
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-2241
Practice Address - Country:US
Practice Address - Phone:224-210-0005
Practice Address - Fax:847-296-6916
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010711363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health