Provider Demographics
NPI:1023353877
Name:ARACKAL, MINIMOL RAVU (RN,MSN,FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MINIMOL
Middle Name:RAVU
Last Name:ARACKAL
Suffix:
Gender:F
Credentials:RN,MSN,FNP-BC
Other - Prefix:MS
Other - First Name:MINIMOL
Other - Middle Name:
Other - Last Name:ANTONY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 DOVER DR
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-5545
Mailing Address - Country:US
Mailing Address - Phone:847-813-9119
Mailing Address - Fax:
Practice Address - Street 1:505 DOVER DR
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-5545
Practice Address - Country:US
Practice Address - Phone:847-813-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.335478163W00000X
IL209010069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily