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General NPI Number Information
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NPI Number | 1194723312
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Entity Type | Individual
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Provider Name | RICKI LOAR APN
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Gender | Female
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 670 PIERCE BLVD
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City | O FALLON
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State | IL
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Zip | 62269-2579
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Country | US
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Telephone | 618-206-2094
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Fax | 618-607-5127
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Provider Business Mailing Address
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Address Line | 3553 W PETERSON AVE SUITE 105
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City | CHICAGO
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State | IL
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Zip | 60659-3200
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Country | US
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Telephone | 773-267-3807
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R0086728
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 209001078
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 209-001078
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209-001078
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | R0086728
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License Number State | OK
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