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NPI Code Detail

MEDICARE: DR. LOLA MARIE PRINCE PHD, APRN, FNP-BC

MEDICARE: DR. LOLA MARIE PRINCE PHD, APRN, FNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner95024565CA
2363LF0000XFamily Nurse Practitioner277000449IL
3363LF0000XFamily Nurse PractitionerAPN000993NV
4363LF0000XFamily Nurse Practitioner12617MN
5363LF0000XFamily Nurse Practitioner219619AZ
6363LF0000XFamily Nurse PractitionerAPRN9486107FL

General Provider Information

NPI Number : 1417957051
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LOLA MARIE PRINCE PHD, APRN, FNP-BC
Provider Business Mailing Address
First Line : 9850 S MARYLAND PKWY STE A5
Second Line :
City : LAS VEGAS
State : NV
Zip : 89183-7148
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11200 LINCOLN HWY
Second Line :
City : MOKENA
State : IL
Zip : 60448-8208
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2005
Last Update Date : 01/19/2026

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