Provider Demographics
NPI:1184492548
Name:PUTHENVEETIL, REEJA ROBERT (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:REEJA
Middle Name:ROBERT
Last Name:PUTHENVEETIL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2340 S HIGHLAND AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5374
Mailing Address - Country:US
Mailing Address - Phone:630-932-2040
Mailing Address - Fax:630-932-1513
Practice Address - Street 1:2340 S HIGHLAND AVE STE 230
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5374
Practice Address - Country:US
Practice Address - Phone:630-932-2040
Practice Address - Fax:630-932-1513
Is Sole Proprietor?:No
Enumeration Date:2023-12-15
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209029320363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily