1467633115 NPI number — SUJATA SHUKLA GUR NURSE PRACTITIONER

Table of content: SUJATA SHUKLA GUR NURSE PRACTITIONER (NPI 1467633115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467633115 NPI number — SUJATA SHUKLA GUR NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUR
Provider First Name:
SUJATA
Provider Middle Name:
SHUKLA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GUR
Provider Other First Name:
SUJATA
Provider Other Middle Name:
H
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1467633115
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2015 S FINLEY RD
Provider Second Line Business Mailing Address:
#707
Provider Business Mailing Address City Name:
LOMBARD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60148-4828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-567-7851
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2013 MIDWEST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK BROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60523-1312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-567-7851
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  209006824 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 209006824 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: IL7391001 . This is a "MEDICARE PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".