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General NPI Number Information
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NPI Number | 1063289478
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Entity Type | Individual
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Provider Name | LUCILLE ELIZABETH SMALLHORN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/06/2023
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 516 W MADISON ST
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City | DANVILLE
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State | IL
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Zip | 61832-5657
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Country | US
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Telephone | 217-962-1892
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Fax |
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Provider Business Mailing Address
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Address Line | 904 BELLEPARK DR
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City | CHAMPAIGN
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State | IL
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Zip | 61821-4172
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Country | US
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Telephone | 217-962-1892
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 209.028680
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209028680
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License Number State | IL
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