Provider Demographics
NPI:1861619280
Name:VACEK, LAUREN (CNP)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:
Last Name:VACEK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 MAPLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1846
Mailing Address - Country:US
Mailing Address - Phone:708-442-1629
Mailing Address - Fax:
Practice Address - Street 1:324 ROOSEVELT RD
Practice Address - Street 2:TAKE CARE CLINIC
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5647
Practice Address - Country:US
Practice Address - Phone:773-702-1679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-004474363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily