Provider Demographics
NPI:1215321435
Name:RACHWALSKI, LAURA J
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:RACHWALSKI
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 1:10709 S PALOS DR
Mailing Address - Street 2:
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465-2226
Mailing Address - Country:US
Mailing Address - Phone:630-221-0200
Mailing Address - Fax:630-384-2240
Practice Address - Street 1:1751 S NAPERVILLE RD
Practice Address - Street 2:200
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-5896
Practice Address - Country:US
Practice Address - Phone:630-682-9700
Practice Address - Fax:630-384-2240
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011745363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner