Basic Information
| Provider Information | |||||||||
| NPI: | 1861561920 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAFIDO | ||||||||
| FirstName: | MARCELLA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1919 S HIGHLAND AVE | ||||||||
| Address2: | SUITE A230 ATTN RAYLENE BOYD | ||||||||
| City: | LOMBARD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601486153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308737305 | ||||||||
| FaxNumber: | 6304163189 | ||||||||
| Practice Location | |||||||||
| Address1: | 429 N YORK ST | ||||||||
| Address2: | ATTN RAYLENE BOYD | ||||||||
| City: | ELMHURST | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601262003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307824050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2006 | ||||||||
| LastUpdateDate: | 07/16/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SM0705X | 209-001613 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Medical-Surgical |
No ID Information.