Provider Demographics
NPI:1508001413
Name:ANDRULIS, LINA (DN)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:ANDRULIS
Suffix:
Gender:F
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5856 W IRVING PARK RD
Mailing Address - Street 2:1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-2622
Mailing Address - Country:US
Mailing Address - Phone:773-282-5409
Mailing Address - Fax:773-282-3868
Practice Address - Street 1:5856 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2622
Practice Address - Country:US
Practice Address - Phone:773-282-5409
Practice Address - Fax:773-282-3868
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181000350172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath