Provider Demographics
NPI:1770333437
Name:BADWAN, RANEN (FNP)
Entity type:Individual
Prefix:MRS
First Name:RANEN
Middle Name:
Last Name:BADWAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8933 WILLOW GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-2300
Mailing Address - Country:US
Mailing Address - Phone:708-743-8512
Mailing Address - Fax:
Practice Address - Street 1:8933 WILLOW GLEN WAY
Practice Address - Street 2:
Practice Address - City:WILLOW SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60480-2300
Practice Address - Country:US
Practice Address - Phone:708-743-8512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILF02240981363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily