Basic Information
| Provider Information | |||||||||
| NPI: | 1083253546 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOTTEN | ||||||||
| FirstName: | VANAJA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 375 GATESHEAD DR | ||||||||
| Address2: | |||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7733877402 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8012 S.CRANDON AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7733565000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2020 | ||||||||
| LastUpdateDate: | 04/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 209.020323 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LG0600X | 209.020323 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 207R00000X | 209.020323 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.