Tibessa Lawrence-Ellis

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

277.003029 Issued in IL

Practice address

835 S Wolcott Ave # E144
Chicago, IL 60612-3748

Phone

(312) 996-7420

NPI assigned

Nov 10, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1415577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730937600000",
    "number": "1679979298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2119 S 24TH AVE",
            "city": "BROADVIEW",
            "state": "IL",
            "postal_code": "601552823",
            "telephone_number": "708-223-0873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 S WOLCOTT AVE # E144",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123748",
            "telephone_number": "312-996-7420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAWRENCE-ELLIS",
        "first_name": "TIBESSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-10",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "277.003029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lawrence House
• Lawrence Lindeman MD SC
• Lawrence M Kaufman, M.D., PH.D., SC
• Lawrence Stone
• Lawrence W Kolar, DDS, PC
• Ashly C Lawrence, LCPC
• Christie Nicole Lawrence, DNP RN APN/CNS
• Christine Lawrence, DPM
• Delaney Lawrence
• Eli Joseph Lawrence, D.D.S

• Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.