Healthcare Provider Details

I. General information

NPI: 1114830080
Provider Name (Legal Business Name): LAUREN PROFITT APRN, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WESTPORT CT
BLOOMINGTON IL
61704-8233
US

IV. Provider business mailing address

3310 TURQUOIS WAY
NORMAL IL
61761-9383
US

V. Phone/Fax

Practice location:
  • Phone: 309-722-4020
  • Fax: 309-740-4440
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number041.529238
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: