Healthcare Provider Details

I. General information

NPI: 1407269939
Provider Name (Legal Business Name): LAUREN MARIE PANNER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS LAUREN MARIE SCHULTZE

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 RAYMOND DR
NAPERVILLE IL
60563-9791
US

IV. Provider business mailing address

636 RAYMOND DR
NAPERVILLE IL
60563-9791
US

V. Phone/Fax

Practice location:
  • Phone: 630-355-5302
  • Fax: 630-778-6088
Mailing address:
  • Phone: 630-355-5302
  • Fax: 630-778-6088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041407182
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209011026
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: