Healthcare Provider Details

I. General information

NPI: 1699740308
Provider Name (Legal Business Name): LORRAINE LEE IOCCA RN,MS,BC-ADM,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2528 FARRAGUT DR
SPRINGFIELD IL
62704-1433
US

IV. Provider business mailing address

2528 FARRAGUT DR
SPRINGFIELD IL
62704-1433
US

V. Phone/Fax

Practice location:
  • Phone: 217-787-8870
  • Fax: 217-787-8234
Mailing address:
  • Phone: 217-787-8870
  • Fax: 217-787-8234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: