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General NPI Number Information
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NPI Number | 1508110347
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Entity Type | Individual
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Provider Name | LATHA S PANICKER APN-BC
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Gender | Female
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Dates
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Enumeration Date | 11/01/2012
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 977 N OAKLAWN AVE SUITE 104
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City | ELMHURST
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State | IL
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Zip | 60126-1045
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Country | US
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Telephone | 800-683-7861
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Fax | 888-856-4648
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Provider Business Mailing Address
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Address Line | 800 S WILMETTE AVE
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City | WESTMONT
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State | IL
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Zip | 60559-8623
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Country | US
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Telephone | 630-696-7594
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209.009961
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License Number State | IL
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