Provider Demographics
NPI:1285075697
Name:KAGAN, YAFFA Y (NP)
Entity type:Individual
Prefix:
First Name:YAFFA
Middle Name:Y
Last Name:KAGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:YAFFA
Other - Middle Name:Y
Other - Last Name:SABGHIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:475-702-3048
Mailing Address - Fax:847-733-5247
Practice Address - Street 1:2650 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1700
Practice Address - Country:US
Practice Address - Phone:475-702-3048
Practice Address - Fax:847-733-5247
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-13
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY630717163W00000X
NY401647363LP0808X
IL309.013317363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse