Provider Demographics
NPI:1861029928
Name:JOSE, NIMISHA
Entity Type:Individual
Prefix:
First Name:NIMISHA
Middle Name:
Last Name:JOSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18600 DALLAS PKWY APT 910
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-4134
Mailing Address - Country:US
Mailing Address - Phone:940-465-3158
Mailing Address - Fax:
Practice Address - Street 1:1309 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-5003
Practice Address - Country:US
Practice Address - Phone:312-413-3000
Practice Address - Fax:312-355-0212
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145636363LF0000X
IL209024772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily