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General NPI Number Information
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NPI Number | 1932700911
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Entity Type | Individual
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Provider Name | LAURA IVETTE PORTILLO APN-CNP
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Gender | Female
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Dates
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Enumeration Date | 11/05/2020
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 9600 GROSS POINT RD STE 1200
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City | SKOKIE
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State | IL
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Zip | 60076-1214
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Country | US
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Telephone | 847-945-7246
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Fax | 847-733-5075
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Provider Business Mailing Address
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Address Line | 9600 GROSS POINT RD STE 1200
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City | SKOKIE
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State | IL
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Zip | 60076-1214
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Country | US
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Telephone | 847-945-7246
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Fax | 847-733-5075
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209022746
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License Number State | IL
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