Healthcare Provider Details

I. General information

NPI: 1629952320
Provider Name (Legal Business Name): JULIA LAVOIE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST
CHICAGO IL
60612-3841
US

IV. Provider business mailing address

222 E PEARSON ST APT 401
CHICAGO IL
60611-7349
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-3034
  • Fax:
Mailing address:
  • Phone: 616-443-4067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041538605
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: