Healthcare Provider Details

I. General information

NPI: 1316517006
Provider Name (Legal Business Name): LAURA A HUARACHA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA A HUARACHA-ARREGUIN

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W LAKE ST
ADDISON IL
60101-1101
US

IV. Provider business mailing address

111 N COUNTY FARM RD
WHEATON IL
60187-3977
US

V. Phone/Fax

Practice location:
  • Phone: 630-682-7400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041473935
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: