Active NPI
Maryam Mustafaa, APN
- Pediatric Nurse Practitioner
- Harvey, IL
National Provider Identifier
1972089944
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 209013508
- Practice address
- 15620 Wood St
Harvey, IL 60426-4171 - Phone
- (708) 333-3030
- NPI assigned
- Jul 12, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 209013508 | IL | Primary |
Addresses
Primary practice location
15620 Wood St
Harvey, IL 60426-4171
Mailing address
4970 Pearson St
Matteson, IL 60443-3108
Phone (773) 851-9850
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209013508 | IL | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531353600000",
"number": "1972089944",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4970 PEARSON ST",
"city": "MATTESON",
"state": "IL",
"postal_code": "604433108",
"telephone_number": "773-851-9850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15620 WOOD ST",
"city": "HARVEY",
"state": "IL",
"postal_code": "604264171",
"telephone_number": "708-333-3030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUSTAFAA",
"first_name": "MARYAM",
"credential": "APN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-12",
"last_updated": "2018-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "IL",
"license": "209013508",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Harvey, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.