Provider Demographics
NPI:1427127992
Name:VAN VUREN, NICOLE ELLEN (OT)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ELLEN
Last Name:VAN VUREN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2942 N WOOD ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4096
Mailing Address - Country:US
Mailing Address - Phone:773-529-2826
Mailing Address - Fax:773-529-4846
Practice Address - Street 1:2942 N WOOD ST
Practice Address - Street 2:UNIT A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4096
Practice Address - Country:US
Practice Address - Phone:773-529-2826
Practice Address - Fax:773-529-4846
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist