Healthcare Provider Details

I. General information

NPI: 1003680877
Provider Name (Legal Business Name): ELLEN V VANDEVENDER DNP, APRN-NP, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/13/2023
Certification Date: 11/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

7S665 CARRIAGE WAY CT
NAPERVILLE IL
60540-8241
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-4000
  • Fax:
Mailing address:
  • Phone: 630-335-5036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number209.028751
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: