Basic Information
| Provider Information | |||||||||
| NPI: | 1194121871 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LA GRIPPE | ||||||||
| FirstName: | HEATHER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2610 N ORCHARD ST | ||||||||
| Address2: | UNIT E | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606147156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308539842 | ||||||||
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| Practice Location | |||||||||
| Address1: | 830 W DIVERSEY PKWY | ||||||||
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| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606141454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732813563 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2014 | ||||||||
| LastUpdateDate: | 11/10/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209012176 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.