Provider Demographics
NPI:1790917755
Name:LAWLOR-KLEAN, PHYLLIS (APN/CNS)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:
Last Name:LAWLOR-KLEAN
Suffix:
Gender:F
Credentials:APN/CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 W 95TH ST
Mailing Address - Street 2:277A
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2600
Mailing Address - Country:US
Mailing Address - Phone:708-684-1148
Mailing Address - Fax:708-684-4645
Practice Address - Street 1:4440 W 95TH ST
Practice Address - Street 2:277A
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2600
Practice Address - Country:US
Practice Address - Phone:708-684-1148
Practice Address - Fax:708-684-4645
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001345163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care