Provider Demographics
NPI:1215432315
Name:MAJOGO-FARHI, EMMY
Entity type:Individual
Prefix:
First Name:EMMY
Middle Name:
Last Name:MAJOGO-FARHI
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 1:4711 GOLF RD STE 1250
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1232
Mailing Address - Country:US
Mailing Address - Phone:847-235-6130
Mailing Address - Fax:847-235-6135
Practice Address - Street 1:5905 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-2845
Practice Address - Country:US
Practice Address - Phone:847-235-6130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017404363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209017404OtherADVANCE NURSE PRACTITIONER LICENSE