Individual
FADERIN BOTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4239 W 95TH ST, OAK LAWN, IL 60453-2623
(708) 519-0188
Mailing address
4236 S LANGLEY AVE, CHICAGO, IL 60653-2912
(708) 228-0464
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
209017876
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209017876
IL
Other
Enumeration date
12/29/2020
Last updated
07/02/2024
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