Individual
AJIE JIBU MAMMARAPPALLIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP
Contact information
Practice address
12251 S 80TH AVE, PALOS HEIGHTS, IL 60463-1290
(708) 923-4000
Mailing address
17704 RADCLIFFE CT, TINLEY PARK, IL 60487-2291
(312) 833-6055
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
209022913
IL
363LG0600X
Gerontology Nurse Practitioner
209022913
IL
Other
Enumeration date
04/30/2021
Last updated
04/30/2021
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