Individual
FARZANEH MOH ENTEZARI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
1701 CURTIS RD, CHAMPAIGN, IL 61822-9678
(217) 365-6207
Mailing address
611 W PARK ST, FAPC, URBANA, IL 61801-2500
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.438415
IL
363LF0000X
Family Nurse Practitioner
Primary
209022654
IL
363LP2300X
Primary Care Nurse Practitioner
209.022654
IL
Other
Enumeration date
02/25/2021
Last updated
11/07/2024
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