Provider Demographics
NPI:1174221816
Name:PAPPACHAN, JASMIN ARAYIL
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:ARAYIL
Last Name:PAPPACHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 CHIPPINGHAM RD # A
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-4624
Mailing Address - Country:US
Mailing Address - Phone:630-445-3538
Mailing Address - Fax:
Practice Address - Street 1:1816 CHIPPINGHAM RD # A
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-4624
Practice Address - Country:US
Practice Address - Phone:630-445-3538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2022151847363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily