Healthcare Provider Details

I. General information

NPI: 1861619280
Provider Name (Legal Business Name): LAUREN VACEK CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 ROOSEVELT RD TAKE CARE CLINIC
GLEN ELLYN IL
60137-5647
US

IV. Provider business mailing address

278 MAPLEWOOD RD
RIVERSIDE IL
60546-1846
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1679
  • Fax:
Mailing address:
  • Phone: 708-442-1629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-004474
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: