Healthcare Provider Details

I. General information

NPI: 1235729302
Provider Name (Legal Business Name): LAURA M. DOMAGALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA MAE DOMAGALA APN-CNP

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9977 WOODS DR STE 100
SKOKIE IL
60077-1057
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 224-364-2273
  • Fax: 847-663-8290
Mailing address:
  • Phone: 847-982-6715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209020615
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.020615
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: