Provider Demographics
NPI:1154962249
Name:LASTER, LAURA ANN (APRN, FNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:LASTER
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 190TH ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3455
Mailing Address - Country:US
Mailing Address - Phone:218-851-5101
Mailing Address - Fax:
Practice Address - Street 1:3135 190TH ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3455
Practice Address - Country:US
Practice Address - Phone:218-851-5101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041446344163W00000X
IN28225021A163W00000X
IL209020064363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse