Provider Demographics
NPI:1356644272
Name:LARA, SILVIA (FNP)
Entity Type:Individual
Prefix:
First Name:SILVIA
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 S WOOD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1202
Mailing Address - Country:US
Mailing Address - Phone:312-996-2000
Mailing Address - Fax:312-413-7812
Practice Address - Street 1:4747 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2508
Practice Address - Country:US
Practice Address - Phone:708-656-4766
Practice Address - Fax:708-652-4745
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
367830Medicare PIN