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General NPI Number Information
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NPI Number | 1720562002
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Entity Type | Individual
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Provider Name | LAURA L NORDGREN AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/21/2018
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 405 LAKE ZURICH RD
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City | BARRINGTON
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State | IL
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Zip | 60010-3141
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Country | US
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Telephone | 847-381-5599
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Fax | 847-381-1431
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Provider Business Mailing Address
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Address Line | 50 S B B KING BLVD STE 100
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City | MEMPHIS
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State | TN
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Zip | 38103-2626
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Country | US
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Telephone | 901-436-1381
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 209018178
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11019182
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License Number State | FL
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