Provider Demographics
NPI:1639486137
Name:TOWLE, THERESA E (DNP, APRN-NP)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:E
Last Name:TOWLE
Suffix:
Gender:F
Credentials:DNP, APRN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19934 WOLF RD UNIT 1036
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-2144
Mailing Address - Country:US
Mailing Address - Phone:480-442-2050
Mailing Address - Fax:708-866-7767
Practice Address - Street 1:18700 WOLF RD STE 211
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8603
Practice Address - Country:US
Practice Address - Phone:480-442-2050
Practice Address - Fax:708-866-7767
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2024-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8085363LP0808X, 363LF0000X
IL277-000054363L00000X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily