Provider Demographics
NPI:1740710300
Name:VRASICH, TARYN ANN (CPNP-PC)
Entity type:Individual
Prefix:MRS
First Name:TARYN
Middle Name:ANN
Last Name:VRASICH
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:TARYN
Other - Middle Name:ANN
Other - Last Name:VESELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14120 JANKOWSKI RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-8547
Mailing Address - Country:US
Mailing Address - Phone:815-355-0019
Mailing Address - Fax:
Practice Address - Street 1:24600 W 127TH ST STE 345
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-9507
Practice Address - Country:US
Practice Address - Phone:815-609-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.019239208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1912043936OtherPEDIATRICS