Provider Demographics
NPI:1881875235
Name:VERLEN, ELLEN (APRN)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:VERLEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E SCRANTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044
Mailing Address - Country:US
Mailing Address - Phone:847-987-2481
Mailing Address - Fax:612-225-1591
Practice Address - Street 1:1900 HOLLISTER DRIVE
Practice Address - Street 2:SUITE 250
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048
Practice Address - Country:US
Practice Address - Phone:847-573-9663
Practice Address - Fax:847-573-9662
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily