Healthcare Provider Details

I. General information

NPI: 1134678683
Provider Name (Legal Business Name): LAURA A EARNEST P. A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1259 RICKERT DR STE 101
NAPERVILLE IL
60540-8904
US

IV. Provider business mailing address

27650 FERRY RD STE 100
WARRENVILLE IL
60555-3846
US

V. Phone/Fax

Practice location:
  • Phone: 630-428-3971
  • Fax:
Mailing address:
  • Phone: 630-225-2663
  • Fax: 630-225-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: