Provider Demographics
NPI:1932967155
Name:VADSARIA, ALIYA I (FNP-BC)
Entity type:Individual
Prefix:
First Name:ALIYA
Middle Name:
Last Name:VADSARIA
Suffix:I
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8604 FERRIS AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2831
Mailing Address - Country:US
Mailing Address - Phone:847-863-6185
Mailing Address - Fax:
Practice Address - Street 1:8604 FERRIS AVE
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2831
Practice Address - Country:US
Practice Address - Phone:847-863-6185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.028014363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily