Provider Demographics
NPI:1801839774
Name:LAU, MARY THERESA ELLEN (RN, MS, APN)
Entity type:Individual
Prefix:MRS
First Name:MARY THERESA
Middle Name:ELLEN
Last Name:LAU
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Gender:F
Credentials:RN, MS, APN
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Mailing Address - Street 1:1209 FRANCES PKWY
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-5129
Mailing Address - Country:US
Mailing Address - Phone:847-698-5971
Mailing Address - Fax:708-202-2180
Practice Address - Street 1:5TH AVENUE & ROOSEVELT RD
Practice Address - Street 2:BLDG 200 RM 546 118S
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-202-8387
Practice Address - Fax:708-202-2180
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
IL364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health