Healthcare Provider Details

I. General information

NPI: 1295539575
Provider Name (Legal Business Name): LOREN WEESE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 BELMONT LN
CAROL STREAM IL
60188-2467
US

IV. Provider business mailing address

1333 BURR RIDGE PKWY STE 200
BURR RIDGE IL
60527-0833
US

V. Phone/Fax

Practice location:
  • Phone: 630-523-8972
  • Fax:
Mailing address:
  • Phone: 630-832-1775
  • Fax: 630-832-3078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209031987
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: