Provider Demographics
NPI:1467951483
Name:TSE, LAURA SUK FONG (APRN, FNP-BC, PCCN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:SUK FONG
Last Name:TSE
Suffix:
Gender:F
Credentials:APRN, FNP-BC, PCCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 S WENTWORTH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-0117
Mailing Address - Country:US
Mailing Address - Phone:872-268-5441
Mailing Address - Fax:
Practice Address - Street 1:2335 S WENTWORTH AVE STE B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-0117
Practice Address - Country:US
Practice Address - Phone:872-268-5441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041391022163W00000X
IL209016429363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse