Healthcare Provider Details

I. General information

NPI: 1437946456
Provider Name (Legal Business Name): SARAH MAGDALENA LAZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S MAPLE AVE
OAK PARK IL
60304-1022
US

IV. Provider business mailing address

10701 S WASHINGTON ST
OAK LAWN IL
60453-5026
US

V. Phone/Fax

Practice location:
  • Phone: 708-383-9300
  • Fax:
Mailing address:
  • Phone: 708-369-6736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.033749
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number041404762
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: