Healthcare Provider Details

I. General information

NPI: 1053545962
Provider Name (Legal Business Name): LORNA K. MACKEBEN RN,CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORNA K. KOBETZ

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 11/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 HEALTH SERVICES DR
DEKALB IL
60115-9637
US

IV. Provider business mailing address

12 HEALTH SERVICES DR
DEKALB IL
60115-9637
US

V. Phone/Fax

Practice location:
  • Phone: 815-756-4875
  • Fax: 815-756-2944
Mailing address:
  • Phone: 815-756-4875
  • Fax: 815-756-2944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041190087
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209007571
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: