Provider Demographics
NPI:1891509436
Name:HOPSON, PAULENA ARENELLA
Entity type:Individual
Prefix:
First Name:PAULENA
Middle Name:ARENELLA
Last Name:HOPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9616 S KARLOV AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3258
Mailing Address - Country:US
Mailing Address - Phone:773-620-8955
Mailing Address - Fax:
Practice Address - Street 1:10436 SOUTHWEST HWY # 2
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-2282
Practice Address - Country:US
Practice Address - Phone:708-636-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209030158363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics