Provider Demographics
NPI:1134603046
Name:DASS, NIRMAL (APN)
Entity type:Individual
Prefix:MS
First Name:NIRMAL
Middle Name:
Last Name:DASS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 BRENTWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-4948
Mailing Address - Country:US
Mailing Address - Phone:815-603-6947
Mailing Address - Fax:
Practice Address - Street 1:1 TIFFANY PT STE 110
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2915
Practice Address - Country:US
Practice Address - Phone:630-924-1160
Practice Address - Fax:630-924-1162
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018028363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209018028OtherIDFPR