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General NPI Number Information
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NPI Number | 1356644272
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Entity Type | Individual
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Provider Name | SILVIA LARA FNP
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Gender | Female
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Dates
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Enumeration Date | 12/15/2010
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Last Update Date | 10/03/2016
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Provider Practice Location Address
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Address Line | 4747 W CERMAK RD
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City | CICERO
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State | IL
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Zip | 60804-2508
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Country | US
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Telephone | 708-656-4766
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Fax | 708-652-4745
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Provider Business Mailing Address
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Address Line | 1220 S WOOD ST
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City | CHICAGO
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State | IL
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Zip | 60608-1202
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Country | US
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Telephone | 312-996-2000
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Fax | 312-413-7812
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209008302
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License Number State | IL
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