MEDICARE: LAURA MCBRIDE FNP-BC

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	209016488	IL

General Provider Information

NPI Number	:	1962908418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MCBRIDE FNP-BC

Provider Business Mailing Address
First Line	:	3637 N SOUTHPORT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-3709
Country	:	US
Telephone Number	:	773-348-5282
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-2127
Country	:	US
Telephone Number	:	312-429-5725
Fax Number	:

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

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	10/18/2023

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