Healthcare Provider Details

I. General information

NPI: 1649814625
Provider Name (Legal Business Name): LETICIA LARTEY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 S MICHIGAN AVE FL 6
CHICAGO IL
60603-3200
US

IV. Provider business mailing address

950 W HURON ST UNIT 402
CHICAGO IL
60642-6845
US

V. Phone/Fax

Practice location:
  • Phone: 312-592-6800
  • Fax:
Mailing address:
  • Phone: 773-934-5610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041407940
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209019742
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: