Provider Demographics
NPI:1568475671
Name:KAVOLIUNAITE, LAURA (MSN, APRN-BC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KAVOLIUNAITE
Suffix:
Gender:F
Credentials:MSN, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S WOOD ST
Mailing Address - Street 2:SUITE 172 ( MC 712)
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-996-5680
Mailing Address - Fax:312-996-5984
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:ROOM 516E (MC521)
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:312-996-2720
Practice Address - Fax:312-996-0022
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277.001086363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner