Provider Demographics
NPI:1245800424
Name:LEE NUNEZ, LAINE MERCEDES (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:LAINE
Middle Name:MERCEDES
Last Name:LEE NUNEZ
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 W ADDISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5952
Mailing Address - Country:US
Mailing Address - Phone:773-281-2217
Mailing Address - Fax:
Practice Address - Street 1:2550 W ADDISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5952
Practice Address - Country:US
Practice Address - Phone:773-281-2217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.022928363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner