Healthcare Provider Details

I. General information

NPI: 1083253546
Provider Name (Legal Business Name): VANAJA THOTTEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8012 S.CRANDON AVE
CHICAGO IL
60617
US

IV. Provider business mailing address

375 GATESHEAD DR
NAPERVILLE IL
60565
US

V. Phone/Fax

Practice location:
  • Phone: 773-356-5000
  • Fax:
Mailing address:
  • Phone: 773-387-7402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209.020323
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209.020323
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number209.020323
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: