Provider Demographics
NPI:1023373479
Name:KNISLEY, LAUREN M (NP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:KNISLEY
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Mailing Address - Street 1:676 N SAINT CLAIR ST
Mailing Address - Street 2:SUITE #850
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2927
Mailing Address - Country:US
Mailing Address - Phone:312-695-0990
Mailing Address - Fax:312-695-0188
Practice Address - Street 1:676 N SAINT CLAIR ST
Practice Address - Street 2:SUITE #850
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2927
Practice Address - Country:US
Practice Address - Phone:312-695-0990
Practice Address - Fax:312-695-0188
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2015-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL209-009009363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily