Basic Information
| Provider Information | |||||||||
| NPI: | 1184758286 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LASTRES | ||||||||
| FirstName: | ALAINA | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SONDAG | ||||||||
| OtherFirstName: | ALAINA | ||||||||
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| OtherCredential: | DNP-PMHNP-BC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 338 PRAIRIE RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | MINOOKA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604478249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153255754 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 21 HERITAGE DR | ||||||||
| Address2: | |||||||||
| City: | BOURBONNAIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609141465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159378204 | ||||||||
| FaxNumber: | 8159378798 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 12/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/17/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 041384739 | IL | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 183700000X | 49156284 | IL | N | Pharmacy Service Providers | Pharmacy Technician | 363LP0808X | 209020254 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.