Individual
LAURA WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 E 51ST ST OFC 7021, PROVIDENT HOSPITAL OF COOK COUNTY, CHICAGO, IL 60615-2400
(312) 572-2647
Mailing address
500 E 51ST ST OFC 7021, PROVIDENT HOSPITAL OF COOK COUNTY, CHICAGO, IL 60615-2400
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-001182
IL
Other
Enumeration date
03/27/2007
Last updated
05/04/2021
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