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General NPI Number Information
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NPI Number | 1548514482
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Entity Type | Organization
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Legal Business Name | MENS HEALTH LASALLE LLC
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 10 S. LASALLE SUITE 1130
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City | CHICAGO
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State | IL
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Zip | 60603
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Country | US
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Telephone | 480-229-1986
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Fax |
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Provider Business Mailing Address
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Address Line | 7611 PRESLAR CT
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City | WINDERMERE
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State | FL
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Zip | 34786-5321
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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 | OWNER
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Name | NIKKI MIGLORE
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Credential |
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Telephone | 480-229-1986
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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 | 209008745
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License Number State | IL
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