Provider Demographics
NPI:1417398777
Name:NATHANSON, ELLEN HAN (APRN, CNP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:HAN
Last Name:NATHANSON
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:A
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:633 EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60208-0844
Mailing Address - Country:US
Mailing Address - Phone:847-491-8100
Mailing Address - Fax:847-491-5919
Practice Address - Street 1:633 EMERSON ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60208-0844
Practice Address - Country:US
Practice Address - Phone:847-491-8100
Practice Address - Fax:847-491-5919
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.022372363LF0000X
IL209022372363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily