DR. LAUREL ANN DETTORE (NPI# 1689929879) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689929879 |
| Entity Type | Individual |
| Full Name | DR. LAUREL ANN DETTORE |
| Credential | DNSC, MS, RN |
| Practice Address |
6827 Stanley Ave Berwyn IL 60402-3287 |
| Practice Telephone | 7087951520 |
| Practice Fax Number | 7087951543 |
| Mailing Telephone | 7087951520 |
| Mailing Fax Number | 7087951543 |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2012-07-13 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LC1500X |
Nurse Practitioner Specialization: Community Health |
214132 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
6827 STANLEY AVE |
| City | BERWYN |
| State | IL |
| Zip Code | 60402-3287 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710967989 | Allen C. Bernthal | Specialist | 6827 Stanley Ave, Berwyn, IL 60402-3287 | 2006-01-22 |
| 1548637226 | Joanne Wheaton | Nurse Practitioner | 6827 Stanley Ave, Berwyn, IL 60402-3287 | 2015-08-28 |
| 1114293123 | Andrew Kowalski | Internal Medicine | 6827 Stanley Ave, Berwyn, IL 60402-3287 | 2012-03-25 |
| 1588972343 | Juan Pablo Ruiz | Internal Medicine | 6827 Stanley Ave, Berwyn, IL 60402-3287 | 2010-09-15 |
| 1366763534 | Allen C Bernthal M D Ltd | Specialist | 6827 Stanley Ave, Berwyn, IL 60402-3287 | 2010-06-22 |
| 1265637623 | Matthew Robert Andersen | Internal Medicine | 6827 Stanley Ave, Berwyn, IL 60402-3287 | 2007-06-18 |
| 1750436051 | Gi and Liver Specialists, Ltd | Specialist | 6827 Stanley Ave, Berwyn, IL 60402-3287 | 2007-01-24 |
| 1548315849 | Midwest Nephrology Associates, LLC | Specialist | 6827 Stanley Ave, Berwyn, IL 60402-3287 | 2007-01-24 |
| 1902959745 | Rajiv J Gandhi | Internal Medicine | 6827 Stanley Ave, Berwyn, IL 60402-3287 | 2007-01-18 |
| 1346220514 | Laurens A. Lohmann | Internal Medicine | 6827 Stanley Ave, Berwyn, IL 60402-3287 | 2006-01-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619586518 | Lisa K Anderson-shaw | Clinical Ethicist | Macneal Trinity Medical Cetner, 3249 Oak Park Avenue, Berwyn, IL 60402 | 2020-07-27 |
| 1922622380 | Ayesha Ikram | Internal Medicine | Macneal Hospital 3249 S. Oak Park Ave, Brewyn, IL 60402 | 2020-06-02 |
| 1598329146 | Eleanor Teoh | Student in an Organized Health Care Education/Training Program | Family Medicine, Macneal Family Medicine Center, 3231 Eucild Ave, 5th Floor, Berwyn, IL 60402 | 2019-04-30 |
| 1376013920 | Virginia Mireles | Behavior Technician | 2317 S. Home, Berwyn, IL 60402 | 2018-11-27 |
| 1245709047 | Saraswati Koirala | Dentist | 1227 S Harlem Ave Apt414, Berwyn, IL 60402 | 2018-11-21 |
| 1295204220 | Dental Town Ltd | Dentist | 7106 W Cermak Rd, Berwyn, IL 60402 | 2018-11-20 |
| 1396231684 | Toya M Gildart | Counselor | Pillars, 6415 Stanley Avenue, Berwyn, IL 60402 | 2018-07-10 |
| 1437655685 | Ana Luisa Desantiago | Social Worker | 3245 Grove Ave Ste 201, Berwyn, IL 60402 | 2018-04-04 |
| 1821520198 | Chetan Velagapudi | Student in an Organized Health Care Education/Training Program | 3231 S Euclid Avenue, Suite 203, Berwyn, IL 60402 | 2017-03-28 |
| 1174976567 | Sydney Talavera | Counselor | 6415 Stanley Ave., Berwyn, IL 60402 | 2016-07-20 |
| Find all providers in zip 60402 | ||||
| Taxonomy Code | 363LC1500X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Community Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538557988 | Ibolya Molnar | Nurse Practitioner | 1420 Caldwell Ln, Hoffman Estates, IL 60169-1202 | 2015-01-07 |
| 1649585407 | Egyptian Health Department | Nurse Practitioner | 1412 Us Highway 45 N, Eldorado, IL 62930-3766 | 2010-08-17 |
| 1639401706 | Ruth A. Miner | Nurse Practitioner | 415 Health Department Rd, Murphysboro, IL 62966-6108 | 2010-02-01 |
| 1639382807 | Lagretta Green | Nurse Practitioner | 200 E 115th St, Chicago, IL 60628-5015 | 2007-05-07 |
Please comment or provide details below to improve the information on DR. LAUREL ANN DETTORE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.