Provider Demographics
NPI:1316650450
Name:LAVRISA, MONICA ANN
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:ANN
Last Name:LAVRISA
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 1:3514 HIGH HILL CIR
Mailing Address - Street 2:
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110-3225
Mailing Address - Country:US
Mailing Address - Phone:847-951-4374
Mailing Address - Fax:
Practice Address - Street 1:212 N DUNTON AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-5915
Practice Address - Country:US
Practice Address - Phone:847-964-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other