Individual
DORIS FANDOHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
3046 127TH ST, BLUE ISLAND, IL 60406-1827
(708) 377-7920
(708) 930-0414
Mailing address
PO BOX 746715, ATLANTA, GA 30374-6715
(773) 352-1515
(312) 929-0373
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209019405
IL
363LF0000X
Family Nurse Practitioner
71008752A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
71008752A
NURSE PRACTITIONER LICENSE NUMBER
IN
Enumeration date
02/08/2019
Last updated
06/06/2025
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