Basic Information
| Provider Information | |||||||||
| NPI: | 1083248660 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOMAROVA | ||||||||
| FirstName: | NADEZHDA | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1603 FAIRWAY DR APT 3E | ||||||||
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| City: | LISLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605323090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3125325629 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1220 HOBSON RD STE 116 | ||||||||
| Address2: | |||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605408137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304163300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2020 | ||||||||
| LastUpdateDate: | 02/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209.020873 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.