Provider Demographics
NPI:1710104328
Name:TUCCO, LAURA JANE (NP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JANE
Last Name:TUCCO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 W LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-2619
Mailing Address - Country:US
Mailing Address - Phone:708-754-9687
Mailing Address - Fax:708-754-3071
Practice Address - Street 1:152 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-2619
Practice Address - Country:US
Practice Address - Phone:708-754-9687
Practice Address - Fax:708-754-3071
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277.000046363LF0000X, 363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK46623Medicare UPIN
ILK46624Medicare UPIN