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General NPI Number Information
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NPI Number | 1396467205
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Entity Type | Individual
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Provider Name | LOUISE M MEDEARIS DNP, APRN, FNP
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Gender | Female
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Dates
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Enumeration Date | 09/16/2022
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 2301 COURT ST
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City | PEKIN
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State | IL
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Zip | 61554-5304
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Country | US
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Telephone | 303-308-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 13999 TOWERLINE RD
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City | PEKIN
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State | IL
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Zip | 61554-8797
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Country | US
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Telephone | 309-267-6314
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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 | 209025466
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License Number State | IL
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