Healthcare Provider Details

I. General information

NPI: 1619787678
Provider Name (Legal Business Name): WOUNDCENTRIX, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11013 N WOODSTOCK ST UNIT 94
HUNTLEY IL
60142-4404
US

IV. Provider business mailing address

2501 CHATHAM RD STE N
SPRINGFIELD IL
62704-4188
US

V. Phone/Fax

Practice location:
  • Phone: 815-781-2680
  • Fax: 815-604-8044
Mailing address:
  • Phone: 815-781-2608
  • Fax: 815-604-8044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: LISA MARIE LORING
Title or Position: CEO
Credential: FNP, C
Phone: 815-781-2608