Doctor Name: | KUNJUMOL PULLATHRA VELAYUDHAN |
NPI Number: | 1124215264 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ANP |
License Number: | 209006239 |
Business Practice Address: | 3650 W 95th St Evergreen Park, IL - 608052108 |
Business Phone Number: | 7084227715 |
Business Fax Number: | 7084227816 |
Mailing Address: | 3650 W 95th St, EVERGREEN PARK |
State: | IL |
Postal Code: | 608052108 |
Phone Number: | 7084227715 |
Fax Number: | 7084227816 |
NPI Enumeration Date: | 10/03/2007 |
NPI Last Update Date: | 02/25/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 209006239 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |