Provider Demographics
NPI:1982164471
Name:SLADEK, LAUREN M (APN)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:SLADEK
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:M
Other - Last Name:MACCRACKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:1050 E NORRIS DR
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-1605
Mailing Address - Country:US
Mailing Address - Phone:815-434-0276
Mailing Address - Fax:815-434-0319
Practice Address - Street 1:1050 E NORRIS DR
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-1605
Practice Address - Country:US
Practice Address - Phone:815-434-0276
Practice Address - Fax:815-434-0319
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019090363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner