Provider Demographics
NPI:1578385571
Name:RANDHAWA, AMRITA KAUR (AGACNP)
Entity type:Individual
Prefix:
First Name:AMRITA
Middle Name:KAUR
Last Name:RANDHAWA
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4718 WINDRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110-3442
Mailing Address - Country:US
Mailing Address - Phone:847-910-3207
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST STE 1106
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3845
Practice Address - Country:US
Practice Address - Phone:312-942-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209030998363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care