| Doctor Name: | MINI PRADEEP |
| NPI Number: | 1275820227 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 209008767 |
| Business Practice Address: | 1032 E Ogden Ave Naperville, IL - 605638618 |
| Business Phone Number: | 6307051208 |
| Business Fax Number: | |
| Mailing Address: | 49 Crab Tree Dr, WESTMONT |
| State: | IL |
| Postal Code: | 605593480 |
| Phone Number: | 6309639412 |
| Fax Number: | 6309639412 |
| NPI Enumeration Date: | 06/28/2011 |
| NPI Last Update Date: | 06/28/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 209008767 |
| 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: | |