Provider Demographics
NPI:1558046292
Name:PICCIRILLO, LAUREN (FNP-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:PICCIRILLO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12814 S OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2223
Mailing Address - Country:US
Mailing Address - Phone:708-408-6831
Mailing Address - Fax:
Practice Address - Street 1:7110 W 127TH ST STE 130
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1579
Practice Address - Country:US
Practice Address - Phone:708-923-6300
Practice Address - Fax:708-923-6303
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.027037363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily