Provider Demographics
NPI:1194536250
Name:RAJAN JAYAKUMAR, NUVANO PREETHI (PMHNP)
Entity type:Individual
Prefix:
First Name:NUVANO PREETHI
Middle Name:
Last Name:RAJAN JAYAKUMAR
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 CHURCHILL RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60195-3221
Mailing Address - Country:US
Mailing Address - Phone:678-772-3423
Mailing Address - Fax:
Practice Address - Street 1:455 DUNHAM RD STE 100
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1453
Practice Address - Country:US
Practice Address - Phone:630-770-3475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.031382363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty