Provider Demographics
NPI:1083177489
Name:PELLETREAU, DENA (DNP)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:PELLETREAU
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:DENA
Other - Middle Name:
Other - Last Name:TAROSAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:880 W CENTRAL RD STE 7100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2379
Mailing Address - Country:US
Mailing Address - Phone:847-618-2500
Mailing Address - Fax:847-392-7834
Practice Address - Street 1:880 W CENTRAL RD STE 7100
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2379
Practice Address - Country:US
Practice Address - Phone:847-618-2500
Practice Address - Fax:847-618-7834
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019115363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209019115OtherIL APN LICENSE NUMBER