Provider Demographics
NPI:1740869650
Name:VANN, ELONDA EVETTE (LPN)
Entity type:Individual
Prefix:MRS
First Name:ELONDA
Middle Name:EVETTE
Last Name:VANN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ELONDA
Other - Middle Name:EVETTE
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4242 W ADAMS ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60624-2655
Mailing Address - Country:US
Mailing Address - Phone:773-708-0083
Mailing Address - Fax:
Practice Address - Street 1:4242 W ADAMS ST APT 2F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-2655
Practice Address - Country:US
Practice Address - Phone:773-708-0083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043.102843164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL164W00000XMedicaid