MEDICARE: MS. LAURA MARIE HEALY NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209-002242	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	209.002242	OTHER	IL	IL LICENSE

General Provider Information

NPI Number	:	1346277480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA MARIE HEALY NP-C

Provider Business Mailing Address
First Line	:	25711 S EGYPTIAN TRL
Second Line	:
City	:	MONEE
State	:	IL
Zip	:	60449-8118
Country	:	US
Telephone Number	:	708-534-7523
Fax Number	:	708-534-7657

Provider Business Practice Location Address
First Line	:	25711 S EGYPTIAN TRL
Second Line	:
City	:	MONEE
State	:	IL
Zip	:	60449
Country	:	US
Telephone Number	:	708-534-7523
Fax Number	:	708-534-7657

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	02/09/2021

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