Healthcare Provider Details

I. General information

NPI: 1285886721
Provider Name (Legal Business Name): LAURA NEILSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 N HIGHLAND AVE
AURORA IL
60506-1404
US

IV. Provider business mailing address

2357 SEQUOIA DR
AURORA IL
60506-6222
US

V. Phone/Fax

Practice location:
  • Phone: 630-859-8700
  • Fax:
Mailing address:
  • Phone: 630-859-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085003311
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number085-003311
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085003311
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: