Healthcare Provider Details

I. General information

NPI: 1134421506
Provider Name (Legal Business Name): ANNA MARIA LENTINI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA MARIA DICARLO

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3132 OLD JACKSONVILLE RD STE 110
SPRINGFIELD IL
62704-7401
US

IV. Provider business mailing address

PO BOX 3428
SPRINGFIELD IL
62708-3428
US

V. Phone/Fax

Practice location:
  • Phone: 217-588-2600
  • Fax:
Mailing address:
  • Phone: 217-588-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209008447
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: