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General NPI Number Information
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NPI Number | 1003025941
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Entity Type | Individual
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Provider Name | KERRI LANUM ATC
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Gender | Female
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 850 BROOKFOREST AVE. F
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City | SHOREWOOD
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State | IL
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Zip | 60404
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Country | US
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Telephone | 815-725-9229
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Fax |
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Provider Business Mailing Address
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Address Line | 527 N. MADISON AVE.
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City | BRADLEY
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State | IL
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Zip | 60915
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Country | US
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Telephone | 815-690-1176
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 96001202
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License Number State | IL
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