Provider Demographics
NPI:1407269939
Name:PANNER, LAUREN MARIE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MARIE
Last Name:PANNER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:SCHULTZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:636 RAYMOND DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-9791
Mailing Address - Country:US
Mailing Address - Phone:630-355-5302
Mailing Address - Fax:630-778-6088
Practice Address - Street 1:636 RAYMOND DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-9791
Practice Address - Country:US
Practice Address - Phone:630-355-5302
Practice Address - Fax:630-778-6088
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041407182163W00000X
IL209011026363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse