Healthcare Provider Details

I. General information

NPI: 1639486137
Provider Name (Legal Business Name): THERESA E TOWLE DNP, APRN-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19250 EVERETT LN STE 201
MOKENA IL
60448-8964
US

IV. Provider business mailing address

19934 WOLF RD UNIT 1036
MOKENA IL
60448-2144
US

V. Phone/Fax

Practice location:
  • Phone: 708-729-5900
  • Fax: 800-396-1601
Mailing address:
  • Phone: 708-729-5900
  • Fax: 800-396-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277-000054
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8085
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277-000054
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277-000054
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP8085
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: