Provider Demographics
NPI:1184758286
Name:LASTRES, ALAINA
Entity type:Individual
Prefix:
First Name:ALAINA
Middle Name:
Last Name:LASTRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALAINA
Other - Middle Name:
Other - Last Name:SONDAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP-PMHNP-BC
Mailing Address - Street 1:338 PRAIRIE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MINOOKA
Mailing Address - State:IL
Mailing Address - Zip Code:60447-8249
Mailing Address - Country:US
Mailing Address - Phone:815-325-5754
Mailing Address - Fax:
Practice Address - Street 1:21 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1465
Practice Address - Country:US
Practice Address - Phone:815-937-8204
Practice Address - Fax:815-937-8798
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020254363L00000X, 363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner