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NPI Code Detail

MEDICARE: MRS. LAUREN ELIZABETH GARDSTROM APN

MEDICARE: MRS. LAUREN ELIZABETH GARDSTROM 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
1363L00000XNurse Practitioner209009248IL
2363LF0000XFamily Nurse Practitioner209009248IL

General Provider Information

NPI Number : 1548538622
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAUREN ELIZABETH GARDSTROM APN
Provider Business Mailing Address
First Line : 2333 W SAINT PAUL AVE
Second Line : APT 212
City : CHICAGO
State : IL
Zip : 60647-5388
Country : US
Telephone Number : 219-688-2970
Fax Number :
Provider Business Practice Location Address
First Line : 2656 N ELSTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-2019
Country : US
Telephone Number : 773-252-1994
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2011
Last Update Date : 11/17/2015

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