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General NPI Number Information
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NPI Number | 1154621662
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Entity Type | Individual
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Provider Name | JENNIFER LASCH RN APN
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Gender | Female
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Dates
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Enumeration Date | 10/30/2010
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Last Update Date | 11/17/2015
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Provider Practice Location Address
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Address Line | 2209 HOWARD ST
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City | EVANSTON
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State | IL
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Zip | 60202-3636
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Country | US
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Telephone | 847-733-1144
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Fax |
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Provider Business Mailing Address
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Address Line | 6461 N NEWLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60631-1744
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209004323
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License Number State | IL
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