MEDICARE: SARAH LAU APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	277003263	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041216822	OTHER	IL	STATE LICENSENO.

General Provider Information

NPI Number	:	1548254378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH LAU APN

Provider Business Mailing Address
First Line	:	4423 N RAVENSWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5802
Country	:	US
Telephone Number	:	773-324-6570
Fax Number	:	773-942-7670

Provider Business Practice Location Address
First Line	:	1740 W TAYLOR ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-7232
Country	:	US
Telephone Number	:	312-996-7296
Fax Number	:	773-536-2406

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	07/08/2024

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Directions to “ SARAH LAU APN” Practice Location

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