Healthcare Provider Details

I. General information

NPI: 1033187844
Provider Name (Legal Business Name): LAARNI E YOGORE ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 N OAKLAWN AVE.
ELMHURST IL
60126-2523
US

IV. Provider business mailing address

278 N OAKLAWN AVE
ELMHURST IL
60126-2523
US

V. Phone/Fax

Practice location:
  • Phone: 708-288-8848
  • Fax:
Mailing address:
  • Phone: 708-288-8848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number96002259
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: