Healthcare Provider Details

I. General information

NPI: 1154184877
Provider Name (Legal Business Name): KAILEE LA HA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 N RANDALL RD STE 210
ELGIN IL
60123-7879
US

IV. Provider business mailing address

13108 SPARROW CT
HOMER GLEN IL
60491-8701
US

V. Phone/Fax

Practice location:
  • Phone: 224-760-7322
  • Fax: 224-535-8252
Mailing address:
  • Phone: 708-595-6524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209029280
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: