Healthcare Provider Details

I. General information

NPI: 1558990960
Provider Name (Legal Business Name): LAUREN GREGORY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

5443 W WARWICK AVE
CHICAGO IL
60641-3228
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-6160
  • Fax: 312-227-9405
Mailing address:
  • Phone: 614-517-0295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209021577
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041388541
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: