Provider Demographics
NPI:1588123277
Name:THAKKAR, RIMA V (AGPCNP)
Entity type:Individual
Prefix:
First Name:RIMA
Middle Name:V
Last Name:THAKKAR
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:768 LAMBERT LN
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-2327
Mailing Address - Country:US
Mailing Address - Phone:630-246-0420
Mailing Address - Fax:
Practice Address - Street 1:768 LAMBERT LN
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-2327
Practice Address - Country:US
Practice Address - Phone:630-246-0420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.018996363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner