Provider Demographics
NPI:1770250177
Name:SANCHEZ, LAURA MENDOZA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MENDOZA
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 LAKE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-3254
Mailing Address - Country:US
Mailing Address - Phone:847-212-4984
Mailing Address - Fax:
Practice Address - Street 1:614 LAKE RIDGE DR
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-3254
Practice Address - Country:US
Practice Address - Phone:847-212-4984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.279693163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult