Provider Demographics
NPI:1356054464
Name:RAVAL, VISHWA (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:VISHWA
Middle Name:
Last Name:RAVAL
Suffix:
Gender:
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:VISHWA
Other - Middle Name:
Other - Last Name:KADAKIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13460 N 94TH DR STE J1
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4264
Mailing Address - Country:US
Mailing Address - Phone:623-876-8816
Mailing Address - Fax:623-298-0168
Practice Address - Street 1:13460 N 94TH DR STE J1
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4264
Practice Address - Country:US
Practice Address - Phone:623-876-8816
Practice Address - Fax:623-298-0168
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.025450363LF0000X
AZ308566363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ308566OtherNP
IL041.480816OtherRN LICENSE