Laura E Kukulski
Individual provider Active NPI Nurse Practitioner · Lyons, IL
NPI 1285101550 · NPPES record last updated Oct 25, 2018
Key facts
- NPI
- 1285101550
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 209.018412 (IL)
- Practice address
- 4101 1St Ave
Lyons, IL 60534-1028 - Phone
- (708) 447-6851
- NPI assigned
- Oct 25, 2018
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209.018412 | IL | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kim and Calvert, M.D., S.C. | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/HHHBCA/Endpoint/HHHBCA
- lkukulski220661@direct.myadvocateaurora.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 209.018412 | IL | Yes |
Addresses
Primary practice location
4101 1St Ave
Lyons, IL 60534-1028
Mailing address
12811 S Cedar LN
Palos Heights, IL 60463-1916
Phone (708) 528-0988
Other providers in Lyons, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 25, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.