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General NPI Number Information
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NPI Number | 1073268009
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Entity Type | Organization
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Legal Business Name | NORTHERN GURNEE LAB, LLC
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Dates
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Enumeration Date | 02/17/2022
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Last Update Date | 02/17/2022
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Provider Practice Location Address
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Address Line | 310 S GREENLEAF ST STE 206
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City | GURNEE
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State | IL
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Zip | 60031-5708
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Country | US
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Telephone | 708-692-3194
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Fax |
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Provider Business Mailing Address
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Address Line | 310 S GREENLEAF ST STE 206
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City | GURNEE
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State | IL
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Zip | 60031-5708
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | HILARY HARRIS
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Credential |
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Telephone | 708-692-3194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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