Provider Demographics
NPI:1639775281
Name:BALE, ANNETTE (RN)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:BALE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24647 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1567
Mailing Address - Country:US
Mailing Address - Phone:847-377-7950
Mailing Address - Fax:
Practice Address - Street 1:24647 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1567
Practice Address - Country:US
Practice Address - Phone:847-377-7950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.273400163WA0400X
IL209024477363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)