Basic Information
| Provider Information | |||||||||
| NPI: | 1346378148 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FETZER | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NURSE PRACTITIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5841 S. MARYLAND AVENUE, MC 2050 | ||||||||
| Address2: | DEPATRTMENT OF GYNECOLOGY | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738341792 | ||||||||
| FaxNumber: | 7737025159 | ||||||||
| Practice Location | |||||||||
| Address1: | 5841 S MARYLAND AVE # 2050 | ||||||||
| Address2: | DEPATRTMENT OF GYNECOLOGY | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606371447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738341792 | ||||||||
| FaxNumber: | 7737025159 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 363LW0102X | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.