Provider Demographics
NPI:1326425570
Name:LAMANTIA, CARLY (APN)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:LAMANTIA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 S MICHIGAN AVE FL 6
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-3200
Mailing Address - Country:US
Mailing Address - Phone:312-592-6800
Mailing Address - Fax:
Practice Address - Street 1:18 S MICHIGAN AVE FL 6
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-3200
Practice Address - Country:US
Practice Address - Phone:312-592-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.011968363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health