Provider Demographics
NPI:1194134387
Name:NIAURIENE, LINA
Entity type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:NIAURIENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6810 JOLIET RD APT 9
Mailing Address - Street 2:
Mailing Address - City:INDIAN HEAD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60525-9018
Mailing Address - Country:US
Mailing Address - Phone:847-693-0637
Mailing Address - Fax:
Practice Address - Street 1:6810 JOLIET RD APT 9
Practice Address - Street 2:
Practice Address - City:INDIAN HEAD PARK
Practice Address - State:IL
Practice Address - Zip Code:60525-9018
Practice Address - Country:US
Practice Address - Phone:847-693-0637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.004117171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor