Provider Demographics
NPI:1235497405
Name:FRANK, THERESA PETREA (APN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:PETREA
Last Name:FRANK
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:PETREA
Other - Last Name:CARRIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:78 JEFFERSON LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-1887
Mailing Address - Country:US
Mailing Address - Phone:847-121-3511
Mailing Address - Fax:
Practice Address - Street 1:675 VARSITY DR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-8176
Practice Address - Country:US
Practice Address - Phone:847-741-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily