Basic Information
| Provider Information | |||||||||
| NPI: | 1003018995 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIHILL | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.M.D., M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 0N622 BOWDISH DR | ||||||||
| Address2: | |||||||||
| City: | GENEVA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601343560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307152821 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 949 W LIBERTY DR | ||||||||
| Address2: | |||||||||
| City: | WHEATON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601874846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307152821 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2007 | ||||||||
| LastUpdateDate: | 02/09/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 019018298 | IL | Y | Dental Providers | Dentist | General Practice | 1223G0001X | 8537 | KY | N | Dental Providers | Dentist | General Practice | 1223P0700X | DS 00870 | MO | N | Dental Providers | Dentist | Prosthodontics | 122300000X | 8537 | KY | N | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 7100044080 | 05 | KY | MEDICAID |