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General NPI Number Information
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NPI Number | 1649814625
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Entity Type | Individual
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Provider Name | LETICIA LARTEY FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/01/2019
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Last Update Date | 11/01/2019
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Provider Practice Location Address
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Address Line | 18 S MICHIGAN AVE FL 6
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City | CHICAGO
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State | IL
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Zip | 60603-3200
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Country | US
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Telephone | 312-592-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 950 W HURON ST UNIT 402
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City | CHICAGO
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State | IL
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Zip | 60642-6845
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Country | US
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Telephone | 773-934-5610
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041407940
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209019742
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License Number State | IL
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