Provider Demographics
NPI:1346277480
Name:HEALY, LAURA MARIE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MARIE
Last Name:HEALY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25711 S EGYPTIAN TRL
Mailing Address - Street 2:
Mailing Address - City:MONEE
Mailing Address - State:IL
Mailing Address - Zip Code:60449-8118
Mailing Address - Country:US
Mailing Address - Phone:708-534-7523
Mailing Address - Fax:708-534-7657
Practice Address - Street 1:25711 S EGYPTIAN TRL
Practice Address - Street 2:
Practice Address - City:MONEE
Practice Address - State:IL
Practice Address - Zip Code:60449
Practice Address - Country:US
Practice Address - Phone:708-534-7523
Practice Address - Fax:708-534-7657
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-002242363LF0000X
IL363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209.002242OtherIL LICENSE
ILP16795Medicare UPIN