Provider Demographics
NPI:1841587045
Name:OPILA, LAUREN MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MARIE
Last Name:OPILA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:ETMEKJIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1 WESTBROOK CORPORATE CENTER
Mailing Address - Street 2:STE. 240
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5701
Mailing Address - Country:US
Mailing Address - Phone:708-236-2673
Mailing Address - Fax:
Practice Address - Street 1:25 N. WINFIELD RD
Practice Address - Street 2:STE 505
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60910
Practice Address - Country:US
Practice Address - Phone:630-339-2225
Practice Address - Fax:630-462-4695
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004058363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical