Individual
PHILSY JOMON EDAKARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
8015 S LUELLA AVE STE 212, CHICAGO, IL 60617-1151
(773) 721-0470
Mailing address
1313 HALLBERG LN, PARK RIDGE, IL 60068-1242
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209.020369
IL
363LF0000X
Family Nurse Practitioner
209.020369
IL
Other
Enumeration date
01/07/2020
Last updated
09/17/2021
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