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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