Provider Demographics
NPI:1407254337
Name:GARCIA, LADY ARIANE (RN,CCRN,MSN,FNP-BC)
Entity Type:Individual
Prefix:
First Name:LADY ARIANE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RN,CCRN,MSN,FNP-BC
Other - Prefix:
Other - First Name:LADY ARIANE
Other - Middle Name:
Other - Last Name:GAVIOLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8625 LAWNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076
Mailing Address - Country:US
Mailing Address - Phone:847-873-4483
Mailing Address - Fax:
Practice Address - Street 1:700 N. WESTMORELAND RD SUITE F
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045
Practice Address - Country:US
Practice Address - Phone:847-873-4483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012133363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner