Provider Demographics
NPI:1558817767
Name:BHATNAGAR, SHIVANI A (CPNP-PC)
Entity type:Individual
Prefix:
First Name:SHIVANI
Middle Name:A
Last Name:BHATNAGAR
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:SHIVANI
Other - Middle Name:A
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP-PC
Mailing Address - Street 1:225 E CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:614-530-1042
Mailing Address - Fax:
Practice Address - Street 1:225 E CHICAGO AVE UNIT 1002
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:612-227-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRNCNP019440363LP0200X
IL209031243363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH611330OtherCGS MEDICARE
OH0213197Medicaid