Provider Demographics
NPI:1275580953
Name:WILENS, NANCY V (ANP/CNP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:V
Last Name:WILENS
Suffix:
Gender:F
Credentials:ANP/CNP
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:V
Other - Last Name:WILENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP/CNP
Mailing Address - Street 1:1347 COVENTRY LN
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4338
Mailing Address - Country:US
Mailing Address - Phone:847-833-4560
Mailing Address - Fax:773-728-8719
Practice Address - Street 1:1347 COVENTRY LN
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4338
Practice Address - Country:US
Practice Address - Phone:847-833-4560
Practice Address - Fax:773-728-8719
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204517Medicare ID - Type Unspecified
S98157Medicare UPIN
ILL96321Medicare PIN