Provider Demographics
NPI:1316497217
Name:THOPPIL, DEEPA JOSE (APN-CNP)
Entity type:Individual
Prefix:
First Name:DEEPA
Middle Name:JOSE
Last Name:THOPPIL
Suffix:
Gender:F
Credentials:APN-CNP
Other - Prefix:
Other - First Name:DEEPA
Other - Middle Name:
Other - Last Name:JOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN-CNP
Mailing Address - Street 1:777 PARK AVE W
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2497
Mailing Address - Country:US
Mailing Address - Phone:847-480-3956
Mailing Address - Fax:847-480-2861
Practice Address - Street 1:777 PARK AVE WEST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035
Practice Address - Country:US
Practice Address - Phone:847-480-3956
Practice Address - Fax:847-480-2861
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041344849163W00000X
IL209014682363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse