Healthcare Provider Details

I. General information

NPI: 1154173524
Provider Name (Legal Business Name): LAUREN NESHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 LAKE COOK RD
NORTHBROOK IL
60062-1447
US

IV. Provider business mailing address

1535 LAKE COOK RD
NORTHBROOK IL
60062-1447
US

V. Phone/Fax

Practice location:
  • Phone: 847-480-1111
  • Fax:
Mailing address:
  • Phone: 847-480-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number085.010545
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: