MEDICARE: LAURA TRUJILLO-CASTELLANOS NP

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	209016841	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2017018975	OTHER	IL	BOARD CERTIFICATION

General Provider Information

NPI Number	:	1588155956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA TRUJILLO-CASTELLANOS NP

Provider Business Mailing Address
First Line	:	PO BOX 746715
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6715
Country	:	US
Telephone Number	:	773-352-1515
Fax Number	:	312-929-0373

Provider Business Practice Location Address
First Line	:	3010 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-4128
Country	:	US
Telephone Number	:	773-377-7735
Fax Number	:

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

Provider Enumeration Date	:	05/22/2018
Last Update Date	:	06/10/2025

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