Provider Demographics
NPI:1730685256
Name:LIM, RUPHY A (APRN, FNP-BC, NP-C)
Entity type:Individual
Prefix:
First Name:RUPHY
Middle Name:A
Last Name:LIM
Suffix:
Gender:F
Credentials:APRN, FNP-BC, NP-C
Other - Prefix:
Other - First Name:RUPHY
Other - Middle Name:A
Other - Last Name:PINEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:380 E NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2290
Mailing Address - Country:US
Mailing Address - Phone:847-867-7924
Mailing Address - Fax:
Practice Address - Street 1:380 E NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-2290
Practice Address - Country:US
Practice Address - Phone:847-867-7924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.017337363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty