Healthcare Provider Details

I. General information

NPI: 1508433376
Provider Name (Legal Business Name): PATRICIA LAST DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1243 RICKERT DR
NAPERVILLE IL
60540-0954
US

IV. Provider business mailing address

14509 MALLARD DR
HOMER GLEN IL
60491-9264
US

V. Phone/Fax

Practice location:
  • Phone: 630-527-6450
  • Fax:
Mailing address:
  • Phone: 773-220-3101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209023664
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041427414
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: