Provider Demographics
NPI:1336772920
Name:KISHTA, NAHAWAND HASAN (APRN-FNP)
Entity Type:Individual
Prefix:
First Name:NAHAWAND
Middle Name:HASAN
Last Name:KISHTA
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-2902
Mailing Address - Country:US
Mailing Address - Phone:708-952-0000
Mailing Address - Fax:708-529-7195
Practice Address - Street 1:5600 W 87TH ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-2902
Practice Address - Country:US
Practice Address - Phone:708-952-0000
Practice Address - Fax:708-529-7195
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily