Healthcare Provider Details

I. General information

NPI: 1699812149
Provider Name (Legal Business Name): PHYLLIS J LAUER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W CENTRAL RD STE 307
ARLINGTON HEIGHTS IL
60005-2467
US

IV. Provider business mailing address

1595 MOMENTUM PL
CHICAGO IL
60689-1595
US

V. Phone/Fax

Practice location:
  • Phone: 847-255-7426
  • Fax: 847-255-6231
Mailing address:
  • Phone: 847-677-6410
  • Fax: 847-677-6420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: