Provider Demographics
NPI:1679133888
Name:PETERS, VANESSA (APN)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 W IRVING PARK RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-5699
Mailing Address - Country:US
Mailing Address - Phone:773-791-3007
Mailing Address - Fax:
Practice Address - Street 1:1511 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1513
Practice Address - Country:US
Practice Address - Phone:847-729-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019453363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner