Provider Demographics
NPI:1730750761
Name:PERIODS & PAUSES; VIRTUAL HEALTHCARE FOR WOMEN PLLC
Entity type:Organization
Organization Name:PERIODS & PAUSES; VIRTUAL HEALTHCARE FOR WOMEN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-FPA
Authorized Official - Phone:630-209-4148
Mailing Address - Street 1:380 E ST CHARLES ROAD
Mailing Address - Street 2:#1363
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2375
Mailing Address - Country:US
Mailing Address - Phone:630-336-4442
Mailing Address - Fax:
Practice Address - Street 1:380 E ST CHARLES ROAD
Practice Address - Street 2:#1363
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2375
Practice Address - Country:US
Practice Address - Phone:630-209-4148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3605639630001Medicaid