Individual
DHARA MEHTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6861 VILLAGREEN VW, ROCKFORD, IL 61107-5639
(779) 696-0250
Mailing address
6861 VILLAGREEN VW, ROCKFORD, IL 61107-5639
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.497979
IL
363LF0000X
Family Nurse Practitioner
Primary
209.029582
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
236
—
DC
Enumeration date
05/03/2023
Last updated
07/12/2025
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