Individual
TAMI S LASALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1045 W STEPHENSON ST, FREEPORT, IL 61032-4864
(815) 599-6000
(815) 599-6933
Mailing address
PO BOX 857, FREEPORT, IL 61032-0857
(815) 599-7925
(815) 599-7923
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041306876
IL
363L00000X
Nurse Practitioner
Primary
209012349
IL
363L00000X
Nurse Practitioner
5512-33
WI
363LA2100X
Acute Care Nurse Practitioner
5512-33
WI
Other
Enumeration date
09/24/2013
Last updated
11/07/2018
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