| Doctor Name: | LAURA NEILSEN |
| NPI Number: | 1285886721 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 085003311 |
| Business Practice Address: | 245 W Roosevelt Rd Bld 14 Suite 150 West Chicago, IL - 601853739 |
| Business Phone Number: | 6302934124 |
| Business Fax Number: | 6302939909 |
| Mailing Address: | 245 W Roosevelt Rd, Bld 14 Suite 150 WEST CHICAGO |
| State: | IL |
| Postal Code: | 601853739 |
| Phone Number: | 6302934124 |
| Fax Number: | 6302939909 |
| NPI Enumeration Date: | 10/15/2008 |
| NPI Last Update Date: | 11/21/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 085003311 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |