Provider Demographics
NPI:1902686090
Name:WROBEL, VANESSA NICOLE (PMHNP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:NICOLE
Last Name:WROBEL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18841 W LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2530
Mailing Address - Country:US
Mailing Address - Phone:708-217-0505
Mailing Address - Fax:
Practice Address - Street 1:18841 W LINDEN AVE
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2530
Practice Address - Country:US
Practice Address - Phone:708-217-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.440529163W00000X
IL209.028364363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse