MOHAMAD ATA
Individual Provider (NPI-1)
Active
Nurse Practitioner
Provider Information
- NPI Number
1457698169- Provider Type
- Individual Provider (NPI-1)
- Status
- Active
Contact & Location
- Address
- 1802 S. MATTIS, CHAMPAIGN, IL, 61821
- Phone
- (217) 383-3311
- Fax
- (630) 690-5282
Specialties & Taxonomies
Nurse Practitioner
Primary License: IL #209017185
Nurse Practitioner, Psych/Mental Health
License: IL #209017185
Registered Nurse
License: IL #041398787