Basic Information
| Provider Information | |||||||||
| NPI: | 1467951483 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TSE | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | SUK FONG | ||||||||
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| Credential: | APRN, FNP-BC, PCCN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1018 W 47TH PL | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606094301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735732681 | ||||||||
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| Practice Location | |||||||||
| Address1: | 396 REMINGTON BLVD STE 230 | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604404304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308924355 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2018 | ||||||||
| LastUpdateDate: | 06/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 041391022 | IL | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 209016429 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.