Healthcare Provider Details

I. General information

NPI: 1396775946
Provider Name (Legal Business Name): LAUREN N DYKENS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W CENTRAL RD
ARLINGTON HTS IL
60005-2349
US

IV. Provider business mailing address

559 W ROSCOE ST 2W
CHICAGO IL
60657-3518
US

V. Phone/Fax

Practice location:
  • Phone: 847-618-3040
  • Fax:
Mailing address:
  • Phone: 573-268-4536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085-002526
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: