Provider Demographics
NPI:1568254738
Name:VAN PUTTEN, VANESSA LAUREN (MSN)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:LAUREN
Last Name:VAN PUTTEN
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 SHADOW HILL DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60124-3815
Mailing Address - Country:US
Mailing Address - Phone:224-253-9064
Mailing Address - Fax:
Practice Address - Street 1:341 SHADOW HILL DR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60124-3815
Practice Address - Country:US
Practice Address - Phone:224-253-9064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist