Provider Demographics
NPI:1699599266
Name:MOHIUDDIN-JAFFAR, NADYAH (APRN)
Entity type:Individual
Prefix:
First Name:NADYAH
Middle Name:
Last Name:MOHIUDDIN-JAFFAR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:NADYAH
Other - Middle Name:
Other - Last Name:MOHIUDDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 WILCOX ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6188
Mailing Address - Country:US
Mailing Address - Phone:800-735-7500
Mailing Address - Fax:
Practice Address - Street 1:500 WILCOX ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6169
Practice Address - Country:US
Practice Address - Phone:800-735-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.033078363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health