Individual ProviderMehrunnissa TajNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address1343 Montclaire Cir, Schaumburg, IL 60173-6180(847) 971-8877PECOS EnrollmentBased on the most recent information from CMS, provider Mehrunnissa Taj does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1003405390Provider TypeIndividualFull NameTaj, MehrunnissaCredentialAPNGenderFemaleSole ProprietorYesEnumeration Date1/12/2021Last Updated1/12/2021Contact InformationPractice LocationPractice Address1343 Montclaire Cir, Schaumburg, IL 60173-6180Phone(847) 971-8877FaxUnlisted FaxMailing LocationMailing Address1343 Montclaire Cir, Schaumburg, IL 60173-6180PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense209014361IllinoisCode163W00000XDescriptionRegistered NurseNursing Service ProvidersLicense041247760Illinois