Provider Demographics
NPI:1770981417
Name:BOX, LAURA (FNP-BC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BOX
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11123 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8076
Mailing Address - Country:US
Mailing Address - Phone:630-904-0788
Mailing Address - Fax:
Practice Address - Street 1:1010 EXECUTIVE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-6135
Practice Address - Country:US
Practice Address - Phone:630-323-0119
Practice Address - Fax:630-323-5357
Is Sole Proprietor?:No
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily