Healthcare Provider Details

I. General information

NPI: 1215193453
Provider Name (Legal Business Name): LORIAN LEIGH WILLIAMS WILLIS APN/CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

3515 BORDEAUX CT
HAZEL CREST IL
60429-2220
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-1081
  • Fax: 708-684-4272
Mailing address:
  • Phone: 708-684-1081
  • Fax: 708-684-4272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number041298510
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: