Healthcare Provider Details

I. General information

NPI: 1841587045
Provider Name (Legal Business Name): LAUREN MARIE OPILA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN MARIE ETMEKJIAN PA-C

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N. WINFIELD RD STE 505
WINFIELD IL
60910
US

IV. Provider business mailing address

1 WESTBROOK CORPORATE CENTER STE. 240
WESTCHESTER IL
60154-5701
US

V. Phone/Fax

Practice location:
  • Phone: 630-339-2225
  • Fax: 630-462-4695
Mailing address:
  • Phone: 708-236-2673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085004058
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: