Provider Demographics
NPI:1891465225
Name:KHAN, WALI SAJJAD (REGISTERED NURSE(RN))
Entity Type:Individual
Prefix:
First Name:WALI
Middle Name:SAJJAD
Last Name:KHAN
Suffix:
Gender:M
Credentials:REGISTERED NURSE(RN)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8103 ROUTE 53 APT 2
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-3644
Mailing Address - Country:US
Mailing Address - Phone:630-210-1740
Mailing Address - Fax:
Practice Address - Street 1:8103 ROUTE 53 APT 2
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-3644
Practice Address - Country:US
Practice Address - Phone:630-210-1740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.027773367500000X
IL041428235163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse