Provider Demographics
NPI:1528503620
Name:ACHANZAR, NIK-NIK (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:NIK-NIK
Middle Name:
Last Name:ACHANZAR
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:NIKNIK
Other - Middle Name:
Other - Last Name:ACHANZAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:5072 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2622
Mailing Address - Country:US
Mailing Address - Phone:872-808-7807
Mailing Address - Fax:
Practice Address - Street 1:344 W HUBBARD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-4407
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277002477363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily