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Organization
ALLURE SKIN AND LASER
Active
Organization
ALLURE SKIN AND LASER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRAH KOPPIE GAVRILOS D.N.P. (NURSE PRACTITIONER)
22480587113
Entity
Organization
Contact information
Practice address
240 E LAKE STREET, ADDISON, IL 60101
(630) 818-7546
Mailing address
832 ROSEMARY TER, DEERFIELD, IL 60015
(224) 805-8713
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
209015215
IL
Other
Enumeration date
02/10/2017
Last updated
02/10/2017
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