Healthcare Provider Details

I. General information

NPI: 1144172958
Provider Name (Legal Business Name): ANDJELA VARAGIC PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 ROOSEVELT RD STE 3-03
GLEN ELLYN IL
60137-5920
US

IV. Provider business mailing address

799 ROOSEVELT RD STE 3-03
GLEN ELLYN IL
60137-5920
US

V. Phone/Fax

Practice location:
  • Phone: 708-356-2400
  • Fax: 708-356-2420
Mailing address:
  • Phone: 708-356-2400
  • Fax: 708-356-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209032758
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: