Healthcare Provider Details

I. General information

NPI: 1093366734
Provider Name (Legal Business Name): LAURA CAMPA APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST STE 21-100
CHICAGO IL
60611-5970
US

IV. Provider business mailing address

675 N SAINT CLAIR ST STE 21-100
CHICAGO IL
60611-5970
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-0990
  • Fax: 312-695-0188
Mailing address:
  • Phone: 312-695-0990
  • Fax: 312-695-0188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.023761
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209023761
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: