Healthcare Provider Details

I. General information

NPI: 1558046292
Provider Name (Legal Business Name): LAUREN PICCIRILLO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7110 W 127TH ST STE 130
PALOS HEIGHTS IL
60463-1579
US

IV. Provider business mailing address

12814 S OAK PARK AVE
PALOS HEIGHTS IL
60463-2223
US

V. Phone/Fax

Practice location:
  • Phone: 708-923-6300
  • Fax: 708-923-6303
Mailing address:
  • Phone: 708-408-6831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.027037
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: