Healthcare Provider Details

I. General information

NPI: 1720480593
Provider Name (Legal Business Name): LAUREN BARNES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21202 OWENS RD STE 201
MOKENA IL
60448-2038
US

IV. Provider business mailing address

21202 OWENS RD STE 201
MOKENA IL
60448-2038
US

V. Phone/Fax

Practice location:
  • Phone: 312-694-7337
  • Fax: 312-695-0156
Mailing address:
  • Phone: 312-694-7337
  • Fax: 312-695-0156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0005561
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085010717
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: