Provider Demographics
NPI:1437656527
Name:THORNTON-MCLENDON, VENESSANN (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:VENESSANN
Middle Name:
Last Name:THORNTON-MCLENDON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 E 114TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-4921
Mailing Address - Country:US
Mailing Address - Phone:708-238-4350
Mailing Address - Fax:773-660-4650
Practice Address - Street 1:33 E 114TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-4921
Practice Address - Country:US
Practice Address - Phone:773-660-4630
Practice Address - Fax:773-660-4650
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.017425363LP2300X
IL277.002828363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care