Provider Demographics
NPI:1043798036
Name:ARNOLD, ELLEN TYESHA (APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:TYESHA
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579 E FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-1470
Mailing Address - Country:US
Mailing Address - Phone:502-418-8482
Mailing Address - Fax:
Practice Address - Street 1:800 DEVON AVE
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4760
Practice Address - Country:US
Practice Address - Phone:800-323-8622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.017824363LF0000X
IL041378473163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty