Provider Demographics
NPI:1699812149
Name:LAUER, PHYLLIS J (APN)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:J
Last Name:LAUER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1595 MOMENTUM PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-1595
Mailing Address - Country:US
Mailing Address - Phone:847-677-6410
Mailing Address - Fax:847-677-6420
Practice Address - Street 1:1100 W CENTRAL RD STE 307
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2467
Practice Address - Country:US
Practice Address - Phone:847-255-7426
Practice Address - Fax:847-255-6231
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner