Healthcare Provider Details

I. General information

NPI: 1710104328
Provider Name (Legal Business Name): LAURA JANE TUCCO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/22/2022
Certification Date: 01/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 W LINCOLN HWY
CHICAGO HEIGHTS IL
60411-2619
US

IV. Provider business mailing address

152 W LINCOLN HWY
CHICAGO HEIGHTS IL
60411-2619
US

V. Phone/Fax

Practice location:
  • Phone: 708-754-9687
  • Fax: 708-754-3071
Mailing address:
  • Phone: 708-754-9687
  • Fax: 708-754-3071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277.000046
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277.000046
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: