Basic Information
| Provider Information | |||||||||
| NPI: | 1346277480 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEALY | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25711 S EGYPTIAN TRL | ||||||||
| Address2: | |||||||||
| City: | MONEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604498118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085347523 | ||||||||
| FaxNumber: | 7085347657 | ||||||||
| Practice Location | |||||||||
| Address1: | 25711 S EGYPTIAN TRL | ||||||||
| Address2: | |||||||||
| City: | MONEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085347523 | ||||||||
| FaxNumber: | 7085347657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 02/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209-002242 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 209.002242 | 01 | IL | IL LICENSE | OTHER |