Basic Information
| Provider Information | |||||||||
| NPI: | 1881875235 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VERLEN | ||||||||
| FirstName: | ELLEN | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 E SCRANTON AVENUE | ||||||||
| Address2: | |||||||||
| City: | LAKE BLUFF | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479872481 | ||||||||
| FaxNumber: | 6122251591 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 HOLLISTER DRIVE | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475739663 | ||||||||
| FaxNumber: | 8475739662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2007 | ||||||||
| LastUpdateDate: | 12/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 277000136 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.