Healthcare Provider Details

I. General information

NPI: 1073968442
Provider Name (Legal Business Name): PRINCESS LOMAX NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 W 95TH ST HEARTLAND CARE PARTNERS
OAK LAWN IL
60453-2256
US

IV. Provider business mailing address

333 N SUMMIT ST FL 7 HCR MANORCARE MEDICAL SERVICES OF FLORIDA LLC
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 800-427-1902
  • Fax: 419-531-2664
Mailing address:
  • Phone: 419-252-6031
  • Fax: 800-564-5952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209013799
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: