Healthcare Provider Details

I. General information

NPI: 1952052896
Provider Name (Legal Business Name): LANA NICOLE LASCHOBER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 01/12/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

1 W SUPERIOR ST APT 4614
CHICAGO IL
60654-8863
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-4000
  • Fax:
Mailing address:
  • Phone: 815-514-0269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209.023194041.453906
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: