Individual
LAURA M VANSELOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3231 S EUCLID, STE. 400, BERWYN, IL 60402
(708) 783-0244
(708) 783-0287
Mailing address
2650 WARRENVILLE RD, STE. 280, DOWNERS GROVE, IL 60515
(630) 324-7900
(630) 271-1813
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
085.002209
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1054932
NCCPA
—
Enumeration date
07/17/2009
Last updated
04/05/2012
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