1295263747 NPI number — LOTUS GERIATRIC NURSE PRACTITIONER CONSULTANTS LLC

Table of content: (NPI 1295263747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295263747 NPI number — LOTUS GERIATRIC NURSE PRACTITIONER CONSULTANTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOTUS GERIATRIC NURSE PRACTITIONER CONSULTANTS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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NPI Number Information

NPI Number:
1295263747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12851 S PONDEROSA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALOS HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60463-1931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-373-7929
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5801 S CASS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTMONT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60559-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-971-2645
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MCCANN
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
ADVANCED PRACTICE NURSE
Authorized Official Telephone Number:
708-373-7929

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  209008833 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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