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General NPI Number Information
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NPI Number | 1407242811
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Entity Type | Organization
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Legal Business Name | LORI ANN MORENO APN LLC
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Dates
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Enumeration Date | 04/13/2015
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Last Update Date | 04/13/2015
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Provider Practice Location Address
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Address Line | 60 REVERE DR STE 100
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City | NORTHBROOK
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State | IL
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Zip | 60062-1590
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Country | US
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Telephone | 224-306-1879
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Fax |
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Provider Business Mailing Address
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Address Line | 512 N EMERSON ST
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City | MOUNT PROSPECT
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State | IL
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Zip | 60056-2104
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Country | US
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Telephone | 224-770-0705
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Fax |
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Authorized Official
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Title or Position | ADVANCED PRACTICE NURSE
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Name | LORI ANN MORENO
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Credential | PMHNP-BC, APN
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Telephone | 224-306-1879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209009279
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License Number State | IL
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