| NPI | 1619787678 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA MARIE LORING CEO 815-781-2608 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care |
| 363LG0600X Nurse Practitioner, Gerontology | |
| Enumeration Date | 2025-01-11 |
| Last Update Date | 2025-12-01 |